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| Please review your registration. If
all information is correct, click the Submit button below. To
make changes to a section, click the Edit button for that
section. |
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| Last Updated:11/26/2005
14:29:40 |
Last Modified
by:Minko Mondeshki |
| Registration
Status:VALID |
Last Modified
by Company:MERLINI-DANIMOND LTD
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| 1a. |
FOREIGN REGISTRATION |
| 1b. |
UPDATE OF REGISTRATION
INFORMATION: Registration
number: 18631335780
Pin
No [C@637fe5 Modify
Pin |
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| FACILITY
NAME: MERLINI-DANIMOND LTD |
| FACILITY
STREET ADDRESS,Line1: Ljubata str. 4-6 |
| FACILITY
STREET ADDRESS,Line2: |
| CITY: Sofija |
STATE/PROVINCE/TERRITORY: Sofija |
| ZIP CODE(POSTAL
CODE): 1407 |
COUNTRY: BULGARIA |
| PHONE
NUMBER (Include Area & Country Code, if
applicable): 359 2 9624074 |
| FAX
NUMBER (Include Area & Country Code, if
applicable): 359 2 9625163 |
| EMAIL
ADDRESS: dmond@spnet.net | | |
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| (Complete this section
only if the Preferred Name/Address is different from the
Facility Name/Address) | |
| NAME: MERLINI-DANIMOND LTD |
| ADDRESS,Line1: Ljubata str. 4-6 |
| ADDRESS,Line2: |
| CITY: Sofija |
STATE/PROVINCE/TERRITORY: Sofija |
| ZIP CODE(POSTAL
CODE): 1407 |
COUNTRY: BULGARIA |
| PHONE NUMBER
(Include Area & Country Code, if applicable): 359 2
9624074 |
| FAX
NUMBER (Include Area & Country Code, if applicable):
359 2 9625163 |
| EMAIL
ADDRESS: dmond@spnet.net | |
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| INDIVIDUAL'S
NAME: Semen Abramov |
| TITLE: director |
| EMERGENCY CONTACT PHONE:
917 4129020 |
| E-MAIL ADDRESS:
olga@safazer.com | |
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| (IF THIS FACILITY
USES TRADE NAMES OTHER THAN THAT LISTED IN SECTION 2 ABOVE,
LIST THEM BELOW (E.G.,"ALSO DOING BUSINESS AS," "FACILITY ALSO
KNOWN AS"): | |
| ALTERNATE TRADE NAME
#1: |
| ALTERNATE TRADE NAME
#2: |
| ALTERNATE TRADE NAME
#3: |
| ALTERNATE TRADE NAME
#4: | |
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| (To be completed for
any facility located outside the United States, District of
Columbia, or the Commonwealth of Puerto
Rico) | |
| NAME OF U.S.
AGENT: Semen Abramov |
| TITLE: director |
| ADDRESS,Line1: 2670 Stillwell Ave., |
| ADDRESS,Line2: Brooklyn |
| CITY: New York |
STATE: NEW
YORK |
| ZIP CODE (POSTAL
CODE): 11224 |
COUNTRY: UNITED
STATES |
| PHONE NUMBER (Include
Area & Country Code, if applicable): 718
3739500 |
| EMERGENCY CONTACT PHONE
NO. (Include Area & Country Code, if applicable):
917 4129020 |
| FAX NUMBER
(Include Area & Country Code, if applicable):
718 3738901 |
| EMAIL
ADDRESS: olga@safazer.com | |
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| (Enter the Approximate
dates during which your facility is open for business, if it
operates on a seasonal
basis.) | |
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| (FILL IN ALL TYPES OF
OPERATIONS THAT ARE PERFORMED AT THIS FACILITY REGARDING THE
MANUFACTURING/PROCESSING, PACKING OR HOLDING OF FOOD)
(OPTIONAL) | |
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| To be completed by all
food facilities, Please see instructions for further examples.
IF NONE OF THE MANDATORY CATEGORIES BELOW APPLY, SELECT BOX
37 | |
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1. Alcoholic Beverages |
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[21 CFR 170.3 (n) (2)] |
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2. Baby (Infant and Junior) Food
Products including Infant Formula |
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(Optional Selection) |
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3. Bakery Products, Dough, Mixes, or
Icings |
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[21 CFR 170.3 (n) (1), (9)] |
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4. Beverage Bases |
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[21 CFR 170.3 (n) (3), (16), (35)]
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5. Candy without Chocolate, Candy
Specialties and Chewing Gum |
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[21 CFR 170.3 (n) (6), (9), (25), (38)]
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6. Cereal Preparations, Breakfast Foods,
Quick Cooking/Instant Cereals |
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[21 CFR 170.3 (n) (4)] |
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7. Cheese and Cheese Products |
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[21 CFR 170.3 (n) (5)] |
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8. Chocolate and Cocoa Products |
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[21 CFR 170.3 (n) (3), (9), (38), (43)]
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9. Coffee and Tea |
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[21 CFR 170.3 (n) (3), (7)] |
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10. Color Additives for Foods |
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[21 CFR 170.3 (o) (4)] |
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11. Dietary Conventional Foods or Meal
Replacements (includes Medical Foods) |
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[21 CFR 170.3 (n) (31)] |
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12. Dietary Supplements |
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Proteins, Amino Acids, Fats and Lipid
Substances |
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[21 CFR 170.3 (o) (20)] |
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Vitamins and Minerals |
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[21 CFR 170.3 (o) (20)] |
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Animal By-Products and Extracts |
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(Optional Selection) |
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Herbals and Botanicals |
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(Optional Selection) |
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13. Dressing and Condiments |
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[21 CFR 170.3 (n) (8), (12)] |
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14. Fishery/ Seafood Products |
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[21 CFR 170.3 (n) (13), (15), (39),
(40)] |
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15. Food Additives, Generally Recognized
as Safe (GRAS) Ingredients, or Other Ingredients Used
for Processing |
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[21 CFR 170.3 (n) (42); 21 CFR 170.3 (o)
(1), (2), (3), (5), (6), (7), (8), (9), (10), (11),
(12), (13), (14), (15), (16), (17), (18), (19), (22),
(23), (24), (25), (26), (27), (28), (29), (30), (31),
(32) |
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16. Food Sweeteners (Nutritive) |
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[21 CFR 170.3 (n) (9), (41); 21 CFR
170.3 (o) (21)] |
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17. Fruits and Fruit
Products |
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[21 CFR 170.3 (n) (16), (27), (28),
(35), (43)] |
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18. Gelatin, Rennet, Pudding Mixes, or
Pie Fillings |
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[21 CFR 170.3 (n) (22)] |
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19. Ice Cream and Related Products
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[21 CFR 170.3 (n) (20), (21)] |
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20. Imitation Milk Products |
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[21 CFR 170.3 (n) (10)] |
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21. Macaroni or Noodle Products |
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[21 CFR 170.3 (n) (23)] |
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22. Meat, Meat Products and Poultry (FDA
Regulated) |
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[21 CFR 170.3 (n) (17), (18), (29),
(34), (40)] |
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23. Milk, Butter, or Dried Milk Products
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[21 CFR 170.3 (n) (12), (30), (31)]
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24. Multiple Food Dinners, Gravies,
Sauces, and Specialties |
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[21 CFR 170.3 (n) (11), (14), (17),
(18), (23), (24), (29), (34), (40)] |
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25. Nut and Edible Seed Products |
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[21 CFR 170.3 (n) (26), (32)] |
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26. Prepared Salad Products |
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[21 CFR 170.3 (n) (11), (17), (18),
(22), (29), (34), (35)] |
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27. Shell Egg and Egg Products |
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[21 CFR 170.3 (n) (11), (14)] |
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28. Snack Food Items (Flour, Meal, or
Vegetable Base) |
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[21 CFR 170.3 (n) (37)] |
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29. Spices, Flavors, and Salts |
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[21 CFR 170.3 (n) (26)] |
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30. Soups |
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[21 CFR 170.3 (n) (39),(40)] |
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31. Soft Drinks and Waters |
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[21 CFR 170.3 (n) (3), (35)] |
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32. Vegetables and Vegetable
Products |
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[21 CFR 170.3 (n) (19), (36)]
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33. Vegetable Oils (includes Olive Oil)
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[21 CFR 170.3 (n) (12)] |
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34. Vegetable Protein Products
(Simulated Meats) |
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[21 CFR 170.3 (n) (33)] |
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35. Whole Grains, Milled Grain Products
(Flours) or Starch |
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[21 CFR 170.3 (n) (1), (23)] |
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36. Most/All Human Food Product
Categories |
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(Optional Selection) |
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37. None of the Above Mandatory
Categories |
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| FOOD FOR ANIMAL
CONSUMPTION(OPTIONAL) | |
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| OWNER,OPERATOR, OR AGENT IN CHARGE
INFORMATION |
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| PROVIDE THE FOLLOWING INFORMATION, IF
DIFFERENT FROM ALL OTHER SECTIONS ON THE FORM. IF INFORMATION
IS THE SAME AS ANOTHER SECTION OF THE FORM,CHECK WHICH
SECTION. |
| Facility Address Preferred Address Parent Address U.S Agent Address |
| NAME OF ENTITY OR INDIVIDUAL WHO IS THE
OWNER,OPERATOR, OR AGENT IN CHARGE: |
Merlini Riccardo SPA |
| ADDRESS,LINE1: Ljubata
str. 4-6 |
| ADDRESS,LINE2: |
| CITY: Sofija |
| STATE/PROVINCE/TERRITORY: Sofija |
| COUNTRY: BULGARIA |
| ZIP CODE: 1407 |
| PHONE NUMBER (Include Area &
Country Code, if applicable): 359 2
9624074 |
| FAX NUMBER (Include Area &
Country Code, if applicable): 359 2
9625163 |
| E-MAIL
ADDRESS: dmond@spnet.net | |
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| The
owner, operator, or agent in charge of the facility, or an
individual authorized by the owner, operator, or agent in
charge of the facility, must submit this form. By
submitting this form to FDA, or by authorizing an individual
to submit this form to FDA, the owner, operator, or agent in
charge of the facility certifies that the above information is
true and accurate. An individual (other than the owner,
operator or agent in charge of the facility) who submits the
form to the FDA also certifies that the above information
submitted is true and accurate and that he/she is authorized
to submit the registration on the facility's behalf. An
individual authorized by the owner, operator, or agent in
charge must below identify by name the individual who
authorized submission of the registration. Under 18 U.S.C
1001, anyone who makes a materially false, fictitious, or
fraudulent statement to the U.S. Government is subject to
criminal penalties. |
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| NAME OF PERSON SUBMITTING THIS REGISTRATION
FROM:
| Minko Mondeshki |
| FILL IN ONE CIRCLE |
| A. OWNER, OPERATOR, OR AGENT IN
CHARGE(STOP HERE, FORM IS COMPLETED) |
| B. INDIVIDUAL AUTHORIZED TO SUBMIT THE
REGISTRATION |
| IF YOU CHECKED BOX B ABOVE,
INDICATE WHO AUTHORIZED YOU TO SUBMIT THE
REGISTRATION: |
| OWNER, OPERATOR, OR AGENT IN
CHARGE(STOP HERE, FORM IS COMPLETED) |
| NAME OF
INDIVIDUAL WHO AUTHORIZED REGISTRATION ON BEHALF OF OWNER,
OPERATOR, OR AGENT IN CHARGE |
| ADDRESS,LINE1: |
| ADDRESS,LINE2: |
| CITY: |
| STATE/PROVINCE/TERRITORY: |
| COUNTRY: |
| ZIP CODE: |
| PHONE NUMBER (Include Area &
Country Code, if applicable):
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| FAX NUMBER (Include Area &
Country Code, if applicable):
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| E-MAIL
ADDRESS: | |
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