Nnjzha Request Form | Saudi Food and Drug Authority

Customer Type: *

Product Type: *

Ticket Type: *

Ticket Subject: *

Ticket Sub Subject: *

Choose Esystem: *

Establishment name according to the commercial register: *

Commercial registration number: *

Establishment type: *

Invoice Number: *

Invoice Date: *

Objected Items: *

Item number:	Type of Violation:	Value:	Justifications to an objection for violation:

Applicant type: *

National ID/ Iqama: *

Email:

فضلاً تعبئة الملف المرفق ورفعه مع الطلب بعد توقيعه

Name: *

Contact Number: *

City: *

Description: *