Toggle navigation Food For Special Medical Purposes (FSMP) Notification Form Language: English English Malti default Caution: JavaScript execution is disabled in your browser or for this website. You may not be able to answer all questions in this survey. Please, verify your browser parameters. 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? Yes No 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, then 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 check the format of your answer. 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 Only numbers may be entered in this field. (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. 2 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 and labelling which include: Outer label Outer box Label Product leaflet Insert Any other label appertaining to the product Please upload at most 10 files Upload files × Upload files 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 Choose one of the following answers If you choose 'Other:' please also specify your choice in the accompanying text field. Bank transfer Cheque (payable to the MCCAA) As per Central Bank of Malta's Directive No. 19, which entered into force on the 1st January 2022, cheques will only be accepted for payments exceeding twenty euro (€20). Bank Account Details Bank name: Bank of Valletta IBAN number: MT14VALL22013000000040019986609 Swift code: VALLMTMT DECLARATIONS (This question is mandatory) Notification Declaration Check all that apply This notification shall not constitute official approval or authorisation of the product, nor does it exempt the notifier from any other obligation under the Food for Special Medical Purposes Regulations or any other relevant legislation or administrative provision.Failure to provide any supporting documentation, as may be required by the Food Safety Commission in accordance with the Food for Special Medical Purposes Regulations (Legal Notice 309/2001), shall constitute an offence under those regulations.The notifier is reminded of the obligation to submit a fresh notification in the event of any changes in the composition of the product and / or its labelling.You are reminded of your obligation to submit correct information to the best of your ability. Failure to do so, and in case of submission of missing or incorrect information, legal action might be taken according to the Food Safety Act Cap. 449. (This question is mandatory) Content Declaration Check all that apply I, hereby declare that the details furnished in this application (including any documents mentioned therein) are true and correct to the best of my knowledge and belief and I undertake to inform the Malta Competition and Consumer Affairs Authority of any changes therein, immediately. In case any of the above information is found to be false, untrue, misleading or misrepresenting, I am aware that I may be held liable for it. I confirm that I have attached all relevant documents with this application form. (This question is mandatory) Data Protection Declaration Check all that apply The Malta Competition and Consumer Affairs Authority ("the Controller") will process your personal data in accordance with the relevant provisions of the General Data Protection Regulation (GDPR), the Data Protection Act (Chapter 586 of the Laws of Malta) and other regulations made thereunder. The Controller will process your personal data for licensing and administrative purposes and to comply with its legal obligations. For further information on how your personal data will be processed refer to the Controllers's privacy policy. I, the data subject, hereby consent to having the Malta Competition and Consumer Affairs Authority collect and process my personal information from this application. Submit Please confirm you want to clear your response? Exit and clear survey ×