Global FS Regulatory

Submitter & Shipper Consignee Carrier Product Review

Submitter Information

Company Name *

FDA Registration #

Contact Name *

Physical Address *

City *

State/Province

Country *

Postal Code

Phone *

Fax

Email *

Shipper Information

Click if Same as Submitter

Company Name *

FDA Registration #

Contact Name *

Physical Address *

City *

State/Province

Country *

Postal Code

Phone *

Fax

Email *

Consignee Information

Company Name *

This consignee is an analytical laboratory.

FDA Registration #

Contact Name *

Physical Address *

City *

State/Province

Country *

Postal Code

Phone *

Fax

Email *

Carrier Information

Mode of Transport *

Purpose of Shipment * Commercial Analysis Personal Samples Transportation & Exportation Other:

Name of Carrier *

Tracking Number *

Mode of Shipment * Air Ground

Date of Arrival *

Time Of Arrival *

Name of Carrier *

Country of Carrier *

Flight Number *

Airway Bill Number *

State that Product is Flying into *

Name of U.S. Airport of Entry *

Date of Arrival *

Time Of Arrival *

Name of Carrier *

Country of Carrier *

Vessel Name *

Container Number *

Voyage Number *

Bill of Lading Number *

State of Entry *

U.S. Port of Entry: (First U.S. Crossing Point) *

Date of Arrival *

Time Of Arrival *

Additional Information

According to the information provided, the shipment is by Sea. The FDA forms ask us for additional information. Please provide the following information in order for us to complete the prior notice:

Name of the warehouse where the product will be stored after arrival to the USA

Address of the warehouse

Name of Carrier *

Country of Carrier *

Vehicle License Number

Bill of Lading Number

State of Entry *

Name of Crossing *

Date of Arrival *

Time Of Arrival *

Name of Carrier *

Country of Carrier *

Rail Car Number

Container Number

Bill of Lading Number

State of Entry *

Name of Crossing *

Date of Arrival *

Time Of Arrival *

Name of Carrier *

Country of Carrier *

Flight Number

State that Product is Flying into *

Name of U.S. Airport of Entry *

Date of Arrival *

Time Of Arrival *

Name of Carrier *

Date of Arrival *

Time Of Arrival *

Product 1

Click if product manufacturer is the same as the shipper

Detailed Product Description *

Number of Units *

Weight/Unit *

Manufacturer *

Street Address *

City *

State/Province *

Country *

Postal Code *

FDA Registration *

Has the product listed above ever been refused entry to another country? *
No, this product has never been refused entry to another country.
Yes, this product has been refused from:

Comments *

Your registration has been sent successfully.

You will receive an e-mail with the confirmation.

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File to complete your Prior Notice with U.S. FDA

Submitter Information

Shipper Information

Consignee Information

Carrier Information

Additional Information

According to the information provided, the shipment is by Sea. The FDA forms ask us for additional information. Please provide the following information in order for us to complete the prior notice:

Product 1

Your registration has been sent successfully.