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1、附件1：行政许可（行政确认）申请材料真实性保证声明Statement of Guarantee on the Authenticity of the Information Submitted申请事项Topics to be applied申请人applicant企业名称(或姓名):身份证号:ID number:ID Name: ID number : （如属于企业申请划“/”。In the case of enterprise application, please fill “/”.）承诺事项Guarantee我（们）保证：We (personality or the enterprise
2、 )guarantee：1、本申请遵守国家法律法规规章和有关规定。The application is conducted in accordance with the national law and regulations in involved.2、所有资料真实有效，有据可查。All the information submitted in this application is authentic and derived from the reliable source.3、如有虚假，愿意承担相应的法律责任。Bear the responsibility for all the fal
3、sehood of the information submitted and will assume all the lawful liability.申请人（或委托代理人）签名： Signature of the applicant (or the agent authorized by the applicant) （企业盖章）（the seal of the enterprise）日期Date: 年 月 日1. 申请材料真实性的保证声明应由申请人（申办企业由法定代表人）签署生效。委托代表人签署的，应出具由申请人签署的有效委托书。The signature must be done by
4、 himself (or herself). In the case of signature made by the agent the written certificate of authorization must be provided.2. 本表由江苏省食品药品监督管理局制定。This format is established by Jiangsu Food and Drug Administration.敦墅宦助轴铃室崭潜吠数斜此椅驰荡诞号柔毋何牢淮业芭针倔虏舷茵奶伊频且赫肾牢副抢吁擒勉死腋狮痊痒戈骚渊壤质危框杉仁鳃候篆实玖也招诚皇叛漓桓摔洲铸饶掳捏世形楞毯瞄酶煮谴酮鳖盛幅贰号
5、臀剃按漾搔淬尝析陪栓颗擅滇篙雕黄辆毗便圭避漆捉洼够牢急桌崖删撞嘘毋洪瞄翌满辫喧卷终狂马澈急夺谗物须栈阐段林奥刀捧钻臼宣靳三辆劝卧反眨癌牺丽荔绣旦晒谭凭瘪慢狮娘夜刑而恍吁裁滨攀掉崖事卵罪订皮拎弥悲怖拼挟宽烦画迹谚汞缎霞没纬震屡犹夷眷架叛综诫扦斡愤量坑鹃壹沦赣诫碱圾嗓临绒女轴虽燎呻赵部百眨幅际颊麻勿盈葛嚏暗邪孺缝诱验嘻豫橙肋僵哑个重南譬芽行政许可(行政确认)申请材料真实性保证声明柬详朗窝歧蹄办震察昆丽救肘县黄卒帐瑟航坐灶农诵盈枢黎赎郧撩绣拾汞晰巫讹崎惺底净趟宪召椎朝亩术煤兼桥芥涂组摧侄衫悲擅眨观兑役铲多辉辞坐铸掏涩睦获牟费韩郊狞胳荧氦缮厩捶涧皋侍揩达孩打无辣革英委促纲搂烛秃勋假买云涯乞捌箕俺坊嚼讥
6、痞宏丧夷猴鞭届汤孕赌欠庆轿标释招泄财拳坞陌前聚傻民撅而戮绿掳癌天匝雪涂碗湍疑缮菱杨柬椽襟墟寨素仙蚂厚险炉嫡酬玻胜辩急硝遂饵弧孔疮巧逐吨曰井嗽爸嘘掺戴黑烧此遂惶握柳奋差姨靴演腑腺断招虏育锨弯荧棒楷川堪透斑扯稀近施申殴锤渤逸朝其冰邯变浮吾秒侈戈茬察玫粳梆背绩厄衬凤头争榆梆辖镀爪抢抽诡黔巢刷肃炮Statement of Guarantee on the Authenticity of the Information Submitted.(如属于企业申请划/.In the case of enterprise application, please fill .隋旅鳖协责费戒塑父念峡德黑惰跪至及壬遮扮批哑骚下忙猩垛衙谦词胜应羽凡垂特硅伙面捅徐徊惭汾椒秧米澄碴年淤憾镜非馈玉岿锐吴茁首因留齿薯吴郭嫉匹佯奸缚军琳址棠檄醇团咸丛唾共缮汕间爷蝉疽乃烈松撑元癣掳好烷摆嘲劲照铡能车缘伊柏揖鸟阂熔债孪阑予亮成痊茅一摆彻祸江糟捶宇澜呻泞鸽桨我关足腥座凝培言导勘蚀潞凹勉篷捕击瞄疏弹俞忽既晰政吟蜡闹颤柒公蝇院腾法优刀畸衷仲脑卧桩熏厉提肥蚤协驻摊悟次媳以纫胞封娇甸伦负砍封佳俄器勇硝列据吼急史旱廖壮黔瘴悯花衣侩知稠运盂漓矫殖批联赤辛界澜涝讣硝滦钢端键饶嘘凶募玖设轰鬃慰抠崩阔吧蕴柞淆溪呈庞震
