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Information Request Form For Tobacco Product Manufacturers - Indiana
| Information Request Form For Tobacco Product Manufacturers Form. This is a Indiana form and can be used in Cigarette Department Of Revenue Statewide . |
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INFORMATION REQUEST FORM FOR TOBACCO PRODUCT MANUFACTURERS 1. For each brand family listed on the TMC-1, provide the following: a. Exact location of the factory, with independent documentation (government or directory sources) that identifies the factory at this site Photographs of the exterior of the factory preferably displaying the company name and/or address. Photographs of the interior preferably showing the equipment used to fabricate cigarettes Documents showing that the plant is licensed to fabricate cigarettes List of cigarette brands (besides the brand family listed on the TMC-1) manufactured at this factory and the name of the company for which each brand is made. Include brands manufactured by this factory both currently and in the past. If the brand families listed on the TMC-1 are made by some entity other than your company, please provide the name, address and contact name for the fabricator and a copy of any agreement or contract between the fabricator and your company regarding the manufacture and/or sale of each brand family. Name, address and phone number of the factory manager(s). b. c. d. e. f. 2. 3. 4. Name and address of corporate officer(s). Formation documents for entity showing date and state of formation. Identify affiliates (see Ind. Code § 24-3-3-3) which are tobacco product manufacturers ("TPMs") per Ind. Code § 24-3-3-10. A copy of your current U.S. Treasury Tobacco Tax Bureau (TTB) permit as a manufacturer and/or as an importer as required by 26 U.S.C. § 5712 and § 5713. Name, address and phone number of the Trademark owner and any license agreement or other document providing permission to your company to use the trademark for each of the brand families listed on the TMC-1. For each brand family (cigarettes only) listed on the TMC-1, provide the name and address of the entity that submitted the ingredient reporting information to the U.S. Secretary of Health and Human Services as required by the Federal Cigarette Labeling and Advertising Act (15 U.S.C. §1335(a)) and attach copies of all certificates of compliance. 5. 6. 7. American LegalNet, Inc. www.FormsWorkFlow.com 8. For each brand family (cigarettes only) listed on the TMC-1, provide a copy of the current FTC rotation plan approval letter and the name and address of the entity that filed the health warning rotation plan with the FTC. For each brand family listed on the TMC-1, provide original packaging for one brand style which is representative of each brand family. Flat empty packs are preferred. Submit new packaging each time you change your packaging or add new brand families. Provide a list of states in which your company is certified and the brand families certified. If any state has refused to list or removed your company from a state's directory, identify the state(s). If your company is or has been a party in any litigation, within the past 5 years, please identify your company's role in the case, all other parties, the court, the caption, the nature of dispute, and the disposition, if any. Please identify intended Indiana distributors. Provide a copy of the manufacturer's license obtained from the Alcohol & Tobacco Commission, pursuant to Indiana Code § 24-3-6-9. If your company is a Non-Participating Manufacturer, and applying for the first time, please submit the NPM Bond Form, pursuant to Indiana Code § 24-3-5.4-13.6. The form can be found on the Indiana Attorney General's website. If your company is a Non-Participating Manufacturer whose principal place of business is located outside the United States, please submit the U.S. Importer Declaration Form, pursuant to Indiana Code § 24-3-5.4-15. The form can be found on the Indiana Attorney General's website. Provide a release allowing the U.S. Customs Office to share any information it has about your company with the Indiana Attorney General's Office. Provide a release allowing the Alcohol and Tobacco Tax Trade Bureau ("TTB") to share any information it has about your company with the Indiana Attorney General's Office. 9. 10. 11. 12. 13. 14. 15. 16. 17. revised 8/24/11 American LegalNet, Inc. www.FormsWorkFlow.com
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