SMALL QUANTITY IMPORTATION (SQI) CLEARANCE

1. Type of application

New Renewal (Attach Previous EMB approval of SQI)

2. Information on chemical importer in the Philippines

Registered Business Name______

Office Address ______

Storage Facility Address ______

Name of contact person ______Designation ______

Telephone ______Fax ______

E-mail ______

3. Category of Registrant Importer Distributor End-user

Country of origin ______

Name of Manufacturer ______

Address of Manufacturer ______

4. Status of Compliance to Environmental Permits

Permit / Permit Number / Date Issued / Expiry Date
Environmental Compliance Certificate or Certificate of Non-Coverage
Permit to Operate (Air Pollution Installations)
Discharge Permit (Wastewater/Effluent)
Hazardous Wastes Generator I.D.

5. Information on chemical substance (SQI Chemical)

Chemical name ______

CAS number ______

Chemical/structural formula ______

Product Name ______

Specific use of the substance ______

6. Inventory status of substance (Check all applicable chemical inventories where the chemical substanceis currently listed.)

US TSCA Canada DSL or NDSL

Australia AICS Korea KECI

JAPAN MITI Philippines – not a PCL substance

Europe EINECS ELINCS

7. Information on product/mixture, containing the chemical substance (if the subject of application is component chemical)

Name of product/mixture (as it will appear on bill of lading) ______

Concentration of SQI chemical in product/mixture (%) ______

Allowed annual import volume of product/mixture based on 1000 kg/yrlimit (kg) ______

Physical Properties of the Chemical (e.g. flammable, corrosive etc.) ______

8. The Material Safety Data Sheet (MSDS) of the chemical substance is attached as Annex ______.

Other attachments (Please specify.) ______

Name of Applicant ______

Signature ______

Date Submitted ______

I acknowledge that this application form is a legally binding document, and I declare, under the penalties of perjury, that the same has been accomplished in good faith, verified by me, and, to the best of my knowledge and belief, is true and correct pursuant to the regulations issued under authority thereof.

______

(Notary Public)

List of Requirements

For New Applications:

  1. Letter transmittal addressed to the Regional Director, EMB-NCR
  2. Accomplished and notarized application form
  3. Material Safety Data Sheet (MSDS) or Safety Data Sheet (SDS) of the product containing the 100% by weight declaration of the components/composition of the product

If there is a proprietary component, request manufacturer to send declaration of components through e-mail at

  1. Copy of the Business Permit or SEC Registration of the Office
  2. Copy of the Business Permit of the Warehouse/Storage Facility

If the warehouse belongs to another entity, attach the Lease Agreement

For Renewal Applications:

  1. Letter transmittal addressed to the Regional Director, EMB-NCR
  2. Accomplished and notarized application form
  3. Photocopy of the SQI for renewal
  4. Material Safety Data Sheet (MSDS) or Safety Data Sheet (SDS) of the product containing the 100% by weight declaration of the components/composition of the product

If there is a proprietary component, request manufacturer to send declaration of components through e-mail at

  1. Bill of Lading of Previous Importations
  2. Summary report of Importation / Delivery / Sales / Inventory of the Product (for Importers and Distributors)
  3. Summary report of Importation / Usage or Consumption / Inventory of the Product (for End-Users or Manufacturers)

Processing Fees:

Permit Fee – PhP 500.00 per new chemical

Documentary Stamp Tax Fee – PhP 15.00