Form F-12 "Application for Certificate of Free Sale (Cfs)" - New Jersey

What Is Form F-12?

This is a legal form that was released by the New Jersey Department of Health - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2012;
  • The latest edition provided by the New Jersey Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form F-12 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Health.

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Download Form F-12 "Application for Certificate of Free Sale (Cfs)" - New Jersey

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New Jersey Department of Health
FOR STATE USE ONLY
Consumer, Environmental and Environmental Health Service
Check/MO No. ______________
Food and Drug Safety Program
P.O. Box 369, Trenton, NJ 08625-0369
Amount
Tendered
$________________
Telephone: 609-826-4935
Fax: 609-826-4990
www.nj.gov/health/foodanddrugsafety
Processor
________________
Date Rec’d
________________
APPLICATION FOR CERTIFICATE OF FREE SALE (CFS)
Name of Company
NJDOH License or Registration Number
Street Address
Telephone Number
(
)
City
State
Zip Code
Email Address (Required)
Is product listed on Certificate of Free Sale under embargo, seizure or other restraint?
Yes
No
If yes, please explain. (Attach additional sheet, if necessary.)
If further verification/Apostille is required, please check below:
Mercer County Clerk’s Office
or
State Treasurer’s Office (must indicate country of destination)
Note: Refer to the Certificate of Free Sale Guidelines for the appropriate fees required.
For more information regarding this service and associated fees, please visit the Department of Treasury’s website at:
http://nj.gov/treasury/revenue/njbgs/gsfaq.shtml#apos2
The following information must be included on the Certificate of Free Sale (CFS) form:
1.) Current date of inspection by the New Jersey Department of Health or the U.S. Food and Drug Administration (in the case
of a Drug Company).
2.) Type of establishment: Food, Drug or Cosmetic establishment.
3.) Name under which establishment is licensed.
4.) Location of licensed establishment where products are manufactured and distributed.
5.) List of products to be certified.
6.) Signature and notarization will be completed by the New Jersey Department of Health.
Additional Requirements:
1.) The document must remain a single paged, typed document. HANDWRITTEN DOCUMENTS WILL NOT BE ACCEPTED.
2.) Please include product labels for all products listed on the Certificate(s).
3.) A certificate of analysis is required for all unfinished ingredients.
4.) Pre-paid return postage is required.
Number of
Fee Per
X
=
Number of Products Per Certificate
Certificates
Total
Certificate
Requested
CFS (3 or less items)
X
$50.00
=
$
X
=
$
CFS (4 through 9 items)
$75.00
CFS (10 through 25 items)
X
$100.00
=
$
Product G.M.P. Certificate
X
$50.00
=
$
General G.M.P. Certificate
X
$50.00
=
$
Sanitary Letter
X
$50.00
=
$
Export Certificate
X
$50.00
=
$
Health Certificate
X
$50.00
=
$
Total Number Enclosed:
Grand Total:
$
IMPORTANT:
Enclose a separate check for the above Grand Total, made payable to the “NJDOH.” Any other checks,
such as to the NJ State Treasurer or the Mercer County Clerk, must be separate checks.
Name of Applicant
Title
Signature
Date
Telephone Number
(
)
F-12
JUL 12
New Jersey Department of Health
FOR STATE USE ONLY
Consumer, Environmental and Environmental Health Service
Check/MO No. ______________
Food and Drug Safety Program
P.O. Box 369, Trenton, NJ 08625-0369
Amount
Tendered
$________________
Telephone: 609-826-4935
Fax: 609-826-4990
www.nj.gov/health/foodanddrugsafety
Processor
________________
Date Rec’d
________________
APPLICATION FOR CERTIFICATE OF FREE SALE (CFS)
Name of Company
NJDOH License or Registration Number
Street Address
Telephone Number
(
)
City
State
Zip Code
Email Address (Required)
Is product listed on Certificate of Free Sale under embargo, seizure or other restraint?
Yes
No
If yes, please explain. (Attach additional sheet, if necessary.)
If further verification/Apostille is required, please check below:
Mercer County Clerk’s Office
or
State Treasurer’s Office (must indicate country of destination)
Note: Refer to the Certificate of Free Sale Guidelines for the appropriate fees required.
For more information regarding this service and associated fees, please visit the Department of Treasury’s website at:
http://nj.gov/treasury/revenue/njbgs/gsfaq.shtml#apos2
The following information must be included on the Certificate of Free Sale (CFS) form:
1.) Current date of inspection by the New Jersey Department of Health or the U.S. Food and Drug Administration (in the case
of a Drug Company).
2.) Type of establishment: Food, Drug or Cosmetic establishment.
3.) Name under which establishment is licensed.
4.) Location of licensed establishment where products are manufactured and distributed.
5.) List of products to be certified.
6.) Signature and notarization will be completed by the New Jersey Department of Health.
Additional Requirements:
1.) The document must remain a single paged, typed document. HANDWRITTEN DOCUMENTS WILL NOT BE ACCEPTED.
2.) Please include product labels for all products listed on the Certificate(s).
3.) A certificate of analysis is required for all unfinished ingredients.
4.) Pre-paid return postage is required.
Number of
Fee Per
X
=
Number of Products Per Certificate
Certificates
Total
Certificate
Requested
CFS (3 or less items)
X
$50.00
=
$
X
=
$
CFS (4 through 9 items)
$75.00
CFS (10 through 25 items)
X
$100.00
=
$
Product G.M.P. Certificate
X
$50.00
=
$
General G.M.P. Certificate
X
$50.00
=
$
Sanitary Letter
X
$50.00
=
$
Export Certificate
X
$50.00
=
$
Health Certificate
X
$50.00
=
$
Total Number Enclosed:
Grand Total:
$
IMPORTANT:
Enclose a separate check for the above Grand Total, made payable to the “NJDOH.” Any other checks,
such as to the NJ State Treasurer or the Mercer County Clerk, must be separate checks.
Name of Applicant
Title
Signature
Date
Telephone Number
(
)
F-12
JUL 12