Personal Declaration

TO WHOM IT MAY CONCERN

Personal Declaration in Relation to Products shipped for my use:
The contents of this package consist of medication, which is for my own personal use. These products are generic products and not available in our country and are equivalent to branded products.

I have ordered these products to treat my deteriorating health condition after consulting with a knowledgeable and competent medical practitioner who has knowledge of their use.

(We recommend you include practitioners name, city, state and phone number here)

Prescription Number:
Practitioner Name:
City:
State:

These products are not new or investigational drugs and this delivery consists of less than a 90 days supply which complies with guidelines for the importation of medicines for personal use.

As I need the enclosed products quickly for my personal health care, I request that you do not delay their clearance / passage to me and request you to ensure they reach me in a timely manner.

Thank you.

____________________ (Full Name)

Address:

Phone: