REPUBLIC OF THE PHILIPPINES )

PROVINCE OF ORIENTAL MINDORO )

MUNICIPALITY OF PINAMALAYAN )

J O I N T A F F I D A V I T

We, BENITO ROXAS & LIEZEL DE VILLA, of Legal ages, Filipino, Married and residents
of Teachers Village, Marfrancisco, Pinamalayan Oriental Mindoro and Bansud, Oriental Mindoro
and employed as OWNER & PHARMACIST, respectively by Pinamalayan Trading, Pinamalayan,
Oriental Mindoro after having been duly sworn in accordance with the law, do hereby depose and
say:
That, Pinamalayan Trading is an applicant for a PDEA license to handle the following
specified controlled drugs:

Name of Controlled Drug/s Purpose of Handling
DIAZEPAM AMPOULE 5mg/ml Supply and Delivery to government
Hospitals.

That, we in behalf of the company and by virtue of this affidavit hereby bind ourselves to all
the provisions of Republic Act 9165 otherwise known as the Comprehensive Dangerous Drugs Act
of 2002 and other implementing rules and regulations and assuring that such law and regulations
shall be faithfully complied with;

That, we are executing this affidavit to attest the truth of the foregoing facts, for whatever
legal intent and purpose it may serve.

IN WITNESS HEREOF, we have hereunto set out hands this 21
st
day of October, 2014 at
Pinamalayan, Oriental Mindoro.



BENITO ROXAS LEIZEL DE VILLA
Affiant Affiant


SUBSCRIBED AND SWORN TO before me this ____ day of October, 2014 at
Pinamalayan, Oriental Mindoro, Philippines. Affiants personally exhibiting their Community Tax
Certificate Nos. 14453672 issued at Pinamalayan, Oriental Mindoro on September 11, 2014 &
__________________________ issued at ________________________________ on
_______________________________.


Doc. No. _____________________
Page No. _____________________
Book No. _____________________
Series of _____________________
REPUBLIC OF THE PHILIPPINES )
PROVINCE OF ORIENTAL MINDORO )
MUNICIPALITY OF PINAMALAYAN )

J O I N T A F F I D A V I T

We, BENITO ROXAS & LIEZEL DE VILLA, of Legal ages, Filipino, Married and residents
of Teachers Village, Marfrancisco, Pinamalayan Oriental Mindoro and Bansud, Oriental Mindoro
and employed as OWNER & PHARMACIST, respectively by Pinamalayan Trading, Pinamalayan,
Oriental Mindoro after having been duly sworn in accordance with the law, do hereby depose and
say:
That, Pinamalayan Trading is an applicant for a PDEA license to handle the following
specified controlled drugs:

Name of Controlled Drug/s Purpose of Handling
DIAZEPAM AMPOULE 5mg/ml Supply and Delivery to government
Hospitals.

That, we in behalf of the company and by virtue of this affidavit hereby bind ourselves to all
the provisions of Republic Act 9165 otherwise known as the Comprehensive Dangerous Drugs Act
of 2002 and other implementing rules and regulations and assuring that such law and regulations
shall be faithfully complied with;

That, we are executing this affidavit to attest the truth of the foregoing facts, for whatever
legal intent and purpose it may serve.

IN WITNESS HEREOF, we have hereunto set out hands this 21
st
day of October, 2014 at
Pinamalayan, Oriental Mindoro.


______________________ ______________________
Affiant Affiant



SUBSCRIBED AND SWORN TO before me this ____ day of October, 2014 at
Pinamalayan, Oriental Mindoro, Philippines. Affiants personally exhibiting their Community Tax
Certificate Nos. 14453672 issued at Pinamalayan, Oriental Mindoro on September 11, 2014 &
__________________________ issued at ________________________________ on
_______________________________.


Doc. No. _____________________
Page No. _____________________
Book No. _____________________
Series of _____________________
PINAMALAYAN TRADING
Teachers Village, Marfrancisco, Pinamalayan, Or.
Mindoro
0908-869-5839/0922-876-9662


October 21, 2014

The Director General
Philippine Drug Enforcement Agency
Natl Govt Center, Diliman, Quezon City

Attention: The Director, Compliance Service

Subject: Letter of Authorization

Dear Sir;

As the owner of Pinamalayan Trading, I hereby delegate my authority to handle dangerous
drugs/dangerous drug preparations/preparations containing Table 1 controlled chemicals in
favor of our drug establishment to LIEZEL DE VILLA. As such, she is authorized to sign for and
in behalf of preparations. Likewise, she will be responsible for its monitoring/safekeeping,
recording and reporting to the Compliance Service, Philippine Drug Enforcement Agency.

In relation, enclosed herewith is the picture, specimen, signature, joint affidavit, NBI Clearance,
PRC/PTR and TIN of LIEZEL DE VILLA.


Very truly yours,


BENITO ROXAS
Owner











Owner Authorized Pharmacist