I understand that any violation of the requirements of the Tobacco Product Manufacturer Directory
Act of the Tobacco Settlement Agreement Act of 2000 is a basis for removal of the manufacturer’s
brand families from the Commonwealth’s Directory of Approved Brands.
I agree that all packaging images submitted with this certification are free of proprietary and
confidential information and may be publicly posted on the Pennsylvania Tobacco Product Directory
website.
I hereby certify, under penalty of perjury, that the Tobacco Product Manufacturer identified in Part
I is a Non-Participating Manufacturer in full compliance with the Tobacco Settlement Agreement
Act, that is a resident of the Commonwealth, or has appointed a registered agent for service of
process, that has established and continuously maintains a qualified escrow fund, and that has
executed a qualified escrow agreement approved by the Attorney General.
I hereby certify under penalty of perjury that the brand families submitted for inclusion on the
Pennsylvania Tobacco Product Directory of Approved Brands are legal to sell in the United States
under the Family Smoking Prevention and Tobacco Control Act and all regulations promulgated
thereunder and therefore have been approved/certified by the FDA and/or are currently under
review by the FDA. If a brand family style has been issued a Non-Substantially Equivalent Order
or any other determination by the FDA making the product no longer able to be sold in the US, we
will notify the Office of Attorney General immediately.
I hereby certify under penalty of perjury that I will continually provide updated information
throughout the year regarding any and all updated documentation to ensure the products
contained on the Pennsylvania Tobacco Product Directory of Approved Brands are able to be legally
sold.
I hereby certify and declare under penalty of perjury that all of the statements and information
contained in the certification, including but not limited to any accompanying statements or
attachments herewith, are true, correct and complete and that I am a person authorized to bind the Tobacco Product Manufacturer making this certification either under the laws of the Commonwealth of Pennsylvania or of the jurisdiction where the manufacturer resides or is
organized.
I affirm under penalty of perjury that the brand families included in this certification are the cigarettes of the undersigned TPM, who takes responsibility either for purposes of calculating payment under the MSA for the relevant year in volume and share determined under the MSA OR purposes of calculating payment of escrow into a qualified escrow account as required under the TSAA.
