New Jersey Department of Health
Consumer, Environmental and Occupational Health Service
Public Health and Food Protection Program
Courier Mail: 135 East State Street, Trenton, NJ 08608
USPS: P.O. Box 369, Trenton, NJ 08625
609-826-4935 | [email protected]
https://nj.gov/health/ceohs/phfpp/export
APPLICATION FOR CERTIFICATE OF FREE SALE (CFS)
Per N.J.S.A. 24: 2-9 and N.J.A.C. 8:21-1.10 et seq.
Enter the name of the business, including the name any third-party business*, that assumes responsibility for the submission of
this application.
Name of Applicant Business:
Enter the name of the business that operates the licensed New Jersey location that is responsible for manufacturing and/or
storage of product
Name of Responsible Business:
Enter the full address of the licensed New Jersey business location responsible for manufacturing and/or storage of product
Full Address of Responsible Business:
Enter the New Jersey Department of Health (NJDOH) Wholesale Food/Cosmetic license number, Refrigerated Warehouse license
number, Non-Alcoholic Beverage license number, or Wholesale Drug-Medical Device registration number issued to the
Responsible Business. Attach a copy of the active license or registration.
New Jersey Department of Health license number:
Enter the current date of inspection by the New Jersey Department of Health or the U.S. Food and Drug Administration. Attach a
copy of the most recent inspection report that verifies the entered date.
Current date of inspection:
REQUIRED: Submit an answer for each line.
1. Type of Products (select all that apply): Cosmetics Food Drugs Medical Devices
2. Is the Responsible Business the distributor or manufacturer of the products? Distributor Manufacturer
3. Is the Responsible Business located in New Jersey? Yes No
4. Are any of the submitted products under embargo, seizure, or restraint? Yes No
5. Is a copy of the active NJDOH license for the Responsible Business attached with this application? Yes No
6. (For Certificate of Free Sale only) Is the submitted certificate a TYPED, single-page document? Yes No
7. Is an electronic payment confirmation number or check/money order included with your application? Yes No
8. Are final product labels included with your application? Yes No
9. (For unfinished ingredients only) Is a certificate of analysis included for each unfinished ingredient? Yes No
10. Is a pre-paid, self-addressed shipping label or return envelope included with your application? Yes No
11. Do any of the requested documents require an Apostille**? Yes No
12. If you answered “Yes” to number 11, did you include postage to and from New Jersey Treasury? Yes No
13. Do you confirm that this application is fully complete and the provided information is accurate? Yes No
*Third Party Business: A third-party distribution or brokering company may apply for a certificate only if the source of products complies with N.J.A.C. 8:21-1.10 et seq. A
third-party applicant is responsible for notifying the Responsible Business of an intention to apply for a certificate and for obtaining a copy of the license and most recent
inspection report directly from the Responsible Business.
**Apostille: All certificates receive a Notary Public signature. Apostilles
and Notary Certifications are further validations in addition to the Notary Public signature. Apostilles
and Notary Certifications certify the good standing of the Department of Health Notary Public. This optional service may be required by some countries as an additional
attachment to a completed and notarized certificate. Most documents do not require an apostille or notary certification. NJDOH does not offer Apostilles or Notary
Certifications, but upon request and as a courtesy may forward completed notarized certificates on your behalf. Apostilles and Notary Certifications are available through
New Jersey Treasury, Division of Revenue and Enterprise Services: https://www.state.nj.us/treasury/revenue/apostilles.shtml
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Indicate the type and number of requested certificate(s).
For a description of each certificate type, visit our website: https://nj.gov/health/ceohs/phfpp/export
Certificate Type Cost Per Each Quantity Requested Total Cost
Certificate of Free Sale (1-3 Products) $50
Export Certificate (up to 25 Products) $50
General Good Manufacturing Practices Certificate (no products) $50
Health Certificate (up to 25 Products) $50
Product Good Manufacturing Practices Certificate (up to 25 Products) $50
Sanitary Letter (no products) $50
Certificate of Free Sale (4-9 Products) $75
Certificate of Free Sale (10-25 Products) $100
Final Combined Total
Visit https://nj.gov/health/ceohs/phfpp/export to pay online with a check or credit card.
Indicate the payment transaction information below. Online payment alone is insufficient to request certificates. Complete this
form and submit as an attachment via email to [email protected] OR make checks payable to NJ Department of Health and
send via USPS or courier to the address at the top of this form. If you submit via email, keep the original paper form for your
records. Do not submit in duplicate.
PAYMENT CONFIRMATION # DATE OF PAYMENT AMOUNT
In the space provided below, type the list of products as they should appear on your requested documents.
In the space provided below, indicate any special wording that you would like to appear on your requested certificates. Special
wording is subject to review and approval by the NJ Department of Health.
Certification
I understand that any infraction of N.J.S.A. 24: 2-9 or N.J.A.C. 8:21-1.10 et seq. may be grounds for the rejection of this application. I have read all
questions, answers, and statements in this application and I understand the content thereof. I hereby certify, under penalty of perjury, that the
information furnished on this application is true, accurate, a
nd correct. I hereby authorize the New Jersey Department of Health, its agents,
servants, and employees to conduct any investigation(s) of my business, professional, social and moral background, qualification and reputation,
as it may deem necessary, proper or desirable. I am aware that if any of the foregoing statements are willingly false, I am subject to penalty or
rejection.
Name of Applicant Title of Applicant
Direct Contact Email (Required) Direct Contact Phone Number Date of Application
Applicant Signature
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