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CHECKLIST OF REQUIREMENTS FOR INITIAL ISSUANCE / …

Republic of the Philippines Department of Health FOOD AND DRUG ADMINISTRATION. Filinvest Corporate City Alabang, City of Muntinlupa CHECKLIST OF REQUIREMENTS FOR INITIAL ISSUANCE / RENEWAL OF. A LICENSE TO OPERATE (LTO) A MEDICAL X-RAY FACILITY. 1. Duly accomplished medical x-ray license application form (2 copies). License application fee (refer to the schedule of fees below). Either a photocopy of the machine validated Land Bank of the Philippines (LBP) OnColl Payment Slip or Manager's Check or Cashier's Check payable to 2. FOOD AND DRUG ADMINISTRATION. For LBP payment, you may visit FDA website through this link for the guidelines for payment portal: pertaining-to-all-regulated-medical-devi ces/cdrrhr-fda-circular/508371-fda-circu lar-no-2018-004.

(FOR INITIAL/VARIATION APPLICATION OF CT SCAN/MAMMOGRAPHY ONLY) 11. Duly filled-up and notarized affidavit of continuous compliance. (FOR RENEWAL APPLICATION ONLY) 12. Photocopy of the business/mayor’s permit or SEC/DTI registration of the facility. (FOR INITIAL/VARIATION APPLICATION ONLY) 13. Photocopy of the latest License to Operate.

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Transcription of CHECKLIST OF REQUIREMENTS FOR INITIAL ISSUANCE / …

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