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Date
COMPANY PROFILE
Company Name
*
Email Address
*
Website
OFFICE ADDRESS
Office Address
*
Telephone number
*
Fax number
PLANT ADDRESS
Plant Address
*
Telephone number
*
Fax number
Type of Organization
*
Corporation
Partnership
Single Proprietorship
SEC Reg. No:
*
Date Reg.:
*
...
DTI Reg. No.:
*
Date Reg.:
*
...
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FDA License to operate as:
*
Drug Manufacturer
Drug Trader
Drug Distributor/Importer
Drug Distributor/Wholesaler
LTO Number
*
Validity
...
FOR DRUG MANUFACTURER
Manufactures own products only
No
Yes
Offers TOLL Manufacturing
No
Yes
Tablets
Capsules
Liquids
Sterile
Others
No
Yes
Please specify
Offers Repacking Services
No
Yes
Blister Repacking
Strip Foil
Bottling
Others
No
Yes
Please specify
Special Services
No
Yes
Research and Development
Others
No
Yes
Please specify
FOR DRUG TRADERS, IMPORTERS, EXPORTERS
Toll Manufacturer/Foreign Principal:
Imports from
Exports to
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Company Pharmacist
Company Pharmacist Name
PRC License number
Until
...
School Graduated
Year
*
Regulatory Affairs Officer
Regulatory Affairs Officer Name
PRC License number
Until
...
School Graduated
Year
*
Medical Director
Medical Director Name
PRC License number
Until
...
Speciality
*
School Graduated
Hospital Affiliation
Sales
*
Administrator
*
Production
*
Accounting
*
Others
*
Total
*
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Delegates to the PCPI
Principal Delegate
Name
Telephone/Fax/CP
*
Birthday
*
...
Position
Length of Services
College Degree
Alternate Delegate
Name
Telephone/Fax/CP
*
Birthday
*
...
Position
Length of Services
College Degree
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Business Information
Type of Marketing
Type Of Marketing
Ethical Promotion
OTC
Generic Marketing
Distribution coverage
Nationwide
Export
Active in Regions
Active in Regions
1
2
3
4
5
6
7
8
9
10
11
12
Source of Sales
% Branded
*
% Generic
*
% OTC
*
% Drugstore
*
% Hospitals
*
% Government
*
% Industrial
*
Marketing and Distribution Network
Own Sales Force
No
Yes
No. of Medical Representatives
*
No. of District Supervisors
*
Distributors
No
Yes
Distributor name
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Ownership and Management
Major Stockholders/Owner/Partners
*
% of Partnership
*
Citizenship
*
Executive Officers
*
Position
*
Major Stockholders/Owner/Partners
% of Partnership
Citizenship
Executive Officers
Position
Major Stockholders/Owner/Partners
% of Partnership
Citizenship
Executive Officers
Position
Affiliation
Name of Organization
Contact number
Name of Organization
Contact number
Sponsor
PCPI Member
Principal Delegate
Agree to our rules and policies
*
We hereby pledge to abide to the rules and policies of the Philippine Chamber in the Pharmaceutical Industry, Inc (PCPI) to the best of our ability.
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Membership Application Requirements
Company Profile
Copy of SEC Documents
Copy of FDA LTO (Valid)
List of Products with corresponding CPR Numbers
Audited Financial Statement of the past year
Letter of endorsement from any member of the Board of Trustees or from two (2) active PCPI Member Companies
Passport Size Picture & resume of the proposed Principal (& alternate) delegate
We hereby pledge to abide to the rules and policies of the Philippine Chamber in the Pharmaceutical Industry, Inc (PCPI) to the best of our ability.
Submitted by
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2023 Board of Trustees
Maria Teresa B. Montejo
President
Dr. Lloyd D. Balajadia
Vice President for Manufacturing
Melvyn P. Padernal
Vice President for Marketing
Atty. Dave Frederick G. Escalona
Corporate Secretary
Evangeline V. Orejola
Treasurer
Debbie Q. Pangan
PRO
Maria Lourdes B. Buensuceso
Director
Linda Tantiansu
Director
Aidylita SD Reyes
Director
Alex Tan
Director
Karen T. Go
Director
Michael Francis A. Dela Cruz
Advisor to the Board
Thelma T. Go
Advisor to the Board
Hiro Budhrani
Advisor to the Board
Edward I. Isaac
Advisor to the Board
Leila D. Banico
PCPI Administrative Director
Lilibeth K. Escueta
PCPI Technical Director