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Food For Special Medical Purposes (FSMP) Notification Form

Notification in terms of the Food Safety Act of 2002 (Cap. 449), Food for Special Medical Purposes, Legal Notice 309 of 2001.
FORM DETAILS
Applications will not be considered valid unless the application form is duly completed and all correct documents and correct labels have been submitted with this form. Payment has to be effected within 3 days from the submission of this form for the application to be considered valid. It is recommended that proof of payment of the applicable fees is submitted via the upload section available hereunder, otherwise the application will not be processed until payment is performed.
NAME OF NOTIFIER

Note: Indicate name of the Notifier as it will appear on the notification receipt.

Format required: Kindly provide the name of company (importer).

(This question is mandatory)
Identity of notifier
e.g. Happy Life Ltd. or Mr John Smith
NOTIFIER'S CONTACT DETAILS

Note: These detaills will not appear on the notification receipt; details are kept within the non-public database of food for special mediacal purposes notified under the legal Notice 309/2001, held by the MCCAA

Format required: Kindly provide the full postal address (P.O Box address not accepted), email address, contact number and full name of the contact person.

(This question is mandatory)
Are you a returning user?

A 'returning user' is one who has at least filled in this form once, from the 3rd of August 2020 onwards. If any personal or company details have changed from when you last submitted this form, the you are kindly asked to click 'No'. By clicking 'Yes', you are declaring that you have already provided your personal details in this form, and will therefore be asked for the email address only.

If you are unsure whether you are a returning user or not, you may either click 'No' or else contact the MCCAA for assistance.

(This question is mandatory)
Address 
(This question is mandatory)
Email address 
Please ensure that the email address is correct as it will be used for acknowledgement purposes and also to get in touch with you.
(This question is mandatory)
Contact number 
(This question is mandatory)
Contact person 
NAME OF THE PRODUCT

Note: Indicate the name of the product as it will appear on the notification receipt

Format of requirement: Kindly provide the manufacturer's name and the specific product name.

(This question is mandatory)
Manufacturer's name
e.g. Healthy Living
(This question is mandatory)
Product name
e.g. Vitamin C (1000mg)
PRODUCT'S WEIGHT
Format requirement: Kindly provide the product's weight or volume
(This question is mandatory)
Product's weight 
e.g. 30 / 60 / 90 capsules or 50g / 100g / 500g or 50ml / 100ml / 500ml
ACTIVE INGREDIENTS LIST
Format requirement: kindly list all the active ingredients present in product. The active ingredients are those ingredients with a nutritional and / or physiological function.
(This question is mandatory)
Active ingredients

e.g. Sodium, Vitamin A, Vitamin D, Vitamin E, Vitamin C, Thiamin, Riboflavin, Niacin, Vitamin B6

e.g. Ginger (Zingiber officinale, root)

RECOMMENDED DAILY DOSAGE
Format Requirement: Kindly indicate the recommended daily dosage as suggested by the manufaturer. 
(This question is mandatory)
Recommended daily dosage
e.g. capsules daily or 2 tablespoons daily or 2 scoops (50g) daily
LABEL OF THE PRODUCT
Note: kindly attach a PDF of the outer label of the product (including, if applicable, outer box, label, product leaflet and / or insert)
Kindly attach any relevant documents
Note: Use this section to upload proof of payment as well.
PAYMENT
Payment of €10 to be effected within 3 days from submission of application
(This question is mandatory)
Payment method

Bank Account Details

Bank name: Bank of Valletta

IBAN number: MT14VALL22013000000040019986609

Swift code: VALLMTMT

DECLARATIONS
(This question is mandatory)

Notification Declaration

(This question is mandatory)
Details
(This question is mandatory)
Content Declaration
(This question is mandatory)
Data Protection Declaration