I, NAME , POSITION , Working for the Following Company

Company Logo Address etc.

December 6, 2012

RE: Free Sale Certificate

I, [NAME],[POSITION], working for the following company:

[COMPANY NAME & ADDRESS]

Certify that the products listed below are manufactured by (Company Name) headquartered in [Company Location]. Provide company affiliation/parent company information if applicable. I further certify that Company Name is FREE to manufacture and sell products within the United States and export for sale to other countries. These products are supplied as raw materials to be further processed and incorporated into formulated drug products as an excipient. The United States Food and Drug Administration (US FDA) does not issue Free Sale Certificates for excipients. The following product(s) are covered by this certification:

For [COMPANY NAME] [SIGNATURE] [NAME] [TITLE]