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FDA Prior Notice Form

Prior Notice is notification to the U.S. Food and Drug Administration (FDA) before food is imported or
offered for import into the United States. Advance notice of import shipments allows FDA, with the support
of the U.S. Customs and Border Protection (CBP), to target import inspections more effectively and help
protect the nation's food supply against terrorist acts and other public health emergencies.
If an article of food arrives at the port of arrival with inadequate Prior Notice (e.g., no prior notice,
inaccurate prior notice, or untimely prior notice), the food is subject to refusal of admission and may not be
delivered to the importer, owner, or consignee.
First Choice Consulting Services Regulatory expert team can help you with proper filing of U.S. FDA Prior
Notice. We submit all of the required Prior Notice information on behalf of you and provide you FDA
issued Bar-coded Confirmation. You are required to attach a photocopy of Bar-coded Prior Notice
Confirmation to your shipping documents.

This form consists the following pages.

Page
DESCRIPTION
No.
1.
Introduction
2.
Shipment by Land, Air, Water
3.

Shipment by Express Carrier

4.

Shipment by International Mail

5.

Shipment by Baggage

6.
7.

Product Information page

Agreement Page

WHO SHOULD COMPLETE

N/A
If shipment or article of food arrives into U.S. by Land,
Air, Water
If shipment or article of food arrives into U.S. by
Express Carrier
If shipment or article of food arrives into U.S. by
International Mail
If shipment or article of food arrives into U.S. by
Baggage (Individual carrying the food).
All
All

For Fee and Payment information, please visit www.fdaregistration-consulting.com

Email signed completed Prior Notice form at firstchoice_consulting@yahoo.com

We are always happy to help you. If you have any questions or need any U.S. FDA Food, Beverage and
Dietary supplement regulatory assistance, please feel free to contact us.

firstchoice_consulting@yahoo.com

www.fdaregistration-consulting.com

Page 1 of 7

FDA Prior Notice Form

SHIPPER / SUBMITTER INFORMATION
Company Name:

Physical Address:

FDA registration Number:

Contact Name:

City:

Email:

State:

Telephone No.:

Postal code:

Fax No.:

Country:

CONSIGNEE INFORMATION
Company Name:

Physical Address:

FDA registration Number:

Contact Name:

City:

Email:

State:

Telephone No.:

Postal code:

Fax No.:

Country:

WAREHOUSE INFORMATION
Same location as Consignee information provided above.
Other Location (If other location, please provide the below information)
Warehouse Name: __________________________ FDA registration number: _______________
Physical Address: _________________________________________________________________
City: ________________________ State: ______________________ Postal code: ___________
CARRIER INFORMATION
Carrier Name: __________________ Anticipated Date / Time of arrival in U.S.: _ _ - _ _ - 201_ / _____
By Land:
Vehicle License Number: ______________________ Bill of Landing Number: ________________
Name of U.S. Border Crossing / State of Entry: ____________________ /_____________________
By Air:
Flight Number: ___________________________ Master Airway Bill Number: ________________
U.S. Port of Entry (Airport / State): _______________________ /___________________________
By Water:
Vessel Name & Voyage Number: ____________ Master Bill of Landing Number: _____________
U.S. Port of Entry / State: _________ / ________ Container Number: ________________________
firstchoice_consulting@yahoo.com

www.fdaregistration-consulting.com

Page 2 of 7

FDA Prior Notice Form

SHIPPER / SUBMITTER INFORMATION
Company Name:

Physical Address:

FDA Registration Number:

Contact Name:

City:

Email:

State:

Telephone No.:

Postal code:

Fax No.:

Country:

CONSIGNEE INFORMATION
Company Name:

Physical Address:

FDA Registration Number:

Contact Name:

City:

Email:

State:

Telephone No.:

Postal code:

Fax No.:

Country:

WAREHOUSE INFORMATION
Same location as Consignee information provided above.
Other Location (If other location, please provide the below information)
Warehouse Name: __________________________ FDA Registration number: ______________
Physical Address: _________________________________________________________________
City: ________________________ State: ______________________ Postal code: ___________
CARRIER INFORMATION
Carrier Name: ________________________________________________________________________
Date of shipment: _ _ - _ _ - 201_

Anticipated Date / Time of arrival in U.S.: _ _ - _ _ - 201_ / _____

Mode of Transportation:
Air Please provide Tracking Number or Airway Bill Number: ______________________________
Land Please provide Tracking Number or Bill of Lading Number: ____________________________
Purpose of Shipment:

Commercial

Research & Development

Analysis

Others: _______

Additional information (if any):

firstchoice_consulting@yahoo.com

www.fdaregistration-consulting.com

Page 3 of 7

FDA Prior Notice Form

SHIPPER / SENDER INFORMATION
Company or Individuals Name:

Physical Address:

FDA Registration Number:

Contact Name:

City:

Email:

State:

Telephone No.:

Postal code:

Fax No.:

Country:

U.S. RECIPIENTS INFORMATION

Company or Individuals Name:

Physical Address:

FDA Registration Number:

Contact Name:

City:

Email:

State:

Telephone No.:

Postal code:

Fax No.:

Country:

CARRIER INFORMATION
Carrier Name: ________________________________________________________________________
Date of shipment: _ _ - _ _ - 201_

Anticipated Date / Time of arrival in U.S.: _ _ - _ _ - 201_ / _____

Mode of Transportation:
Air Please provide Tracking Number or Airway Bill Number: ______________________________
Land Please provide Tracking Number or Bill of Lading Number: ____________________________

Additional information (if any):

firstchoice_consulting@yahoo.com

www.fdaregistration-consulting.com

Page 4 of 7

FDA Prior Notice Form

INDIVIDUALS INFORMATION
(Who is carrying or accompanying the food)
Individuals Name:

Physical Address:

FDA registration Number:

City:

Email:

State:

Telephone No.:

Postal code:

Fax No.:

Country:

INDIVIDUALS LOCATION INFORMATION

(Where she/he will be staying upon arrival in USA)
Physical Address:

City:

Email:

State:

Telephone No.:

Postal code:

Fax No.:

Country:

FLIGHT INFORMATION
Flight / Airline Name: __________________________________________________________________
Flight Number: _________________________________

Country of Airline: ____________________

U.S. Port of Entry (Airport / State): ____________________________ /__________________________

Anticipated Date / Time of arrival in U.S.: _ _ - _ _ - 201_ / ____________________________________

Additional information (if any):

firstchoice_consulting@yahoo.com

www.fdaregistration-consulting.com

Page 5 of 7

PRODUCT INFORMATION
1. Product Name or Description: _________________________________________________________
Production Identifier (if applicable): _______________ Product Code (if available): ____________
Type of Packaging:
Bulk:
Total Quantity: ________________________________ Unit of Measure: _________
Packaged: Base unit: __________ Total no. of Base units: ______ Unit of Measure: _________
Total Quantity: ______ Packaging Type: ____________________________________
* Company Information
Company Type
Grower / Consolidator. *
Company Name: _________________________
Manufacturer
FDA Registration number: __________________
Manufacturer is same as shipper mentioned above. Physical Address: ________________________
Manufacturer is a different company. *
City: ___________ State: __________________
* Requires Company information.
Postal code: _____ Country: ________________
2. Product Name or Description: _________________________________________________________
Production Identifier (if applicable): _______________ Product Code (if available): ____________
Type of Packaging:
Bulk:
Total Quantity: ________________________________ Unit of Measure: _________
Packaged: Base unit: __________ Total no. of Base units: ______ Unit of Measure: ________
Total Quantity: ______ Packaging Type: ___________________________________
* Company Information
Company Type
Grower / Consolidator. *
Company Name: _________________________
Manufacturer
FDA Registration number: __________________
Manufacturer is same as shipper mentioned above. Physical Address: ________________________
Manufacturer is a different company. *
City: ___________ State: __________________
* Requires Company information.
Postal code: _____ Country: ________________
Additional Product information (if any): ______________________________________________________
(Note: If you have more than 2 products, please photocopy this page and complete with additional products information.)

PRODUCT REFUSAL INFORMATION

Did any of the above products are refused entry by any country/countries?
No
Yes (if yes, please provide Product name: ______________ Countries of refusal: _______________
PAYMENT INFORMATION
PayPal Transaction Number (ID): ________________________________________________________
Date of Payment: _ _ - _ _ - 201__

firstchoice_consulting@yahoo.com

www.fdaregistration-consulting.com

Page 6 of 7

AGREEMENT
First Choice Consulting Services and the undersigned party have today entered into an agreement
regarding the provision of consulting services on the terms and conditions laid out in this Agreement.

The services provided by First Choice Consulting Services will be performed in a professional
manner in accordance with generally accepted industry standards.

The Client agrees to provide accurate and sufficient information, adequate technical assistance
and documentation, required for First Choice Consulting Services to be able to perform the
Services. The Client shall promptly provide further information that First Choice Consulting
Services reasonably deems relevant to perform the task.

The Client is solely responsible for the scientific accuracy, material facts and completeness of
information provided to First Choice Consulting Services.

Customer authorizes First Choice Consulting Services to submit the furnished FDA Prior Notice
information to the U.S. Food and Drug Administration (FDA) or other agency required by law.

For the Services provided by First Choice Consulting Services, Customer agrees to pay First
Choice Consulting Services the fees set forth in a quote issued by First Choice Consulting
Services to Customer or as otherwise agreed to by First Choice Consulting Services and
Customer plus any applicable taxes or other charges.

The Parties agree to make all reasonable efforts, in good faith, to resolve any dispute arising
from implementation of this agreement through informal discussions and the development of
mutual satisfactory options.

First Choice Consulting Services liability in whatever kind or nature cannot exceed the fee for
performing the task.

This Agreement shall terminate automatically upon completion by First Choice Consulting
Services of the Services required by this Agreement.

First Choice Consulting Services is a Private business entity and is not affiliated with U.S. FDA.

By singing below, Customer agrees to be bound by this Agreement:

Company Name: _________________________ Signature: _____________________________________
Date: _ _ - _ _ - 201__

Authorized Person Name: _________________________

(Managing Director, Proprietor, General Manager, etc.)

Place: __________________________________ Job Title: ______________________________________

firstchoice_consulting@yahoo.com

www.fdaregistration-consulting.com

Page 7 of 7