e-form

Application for a Wholesale Dealer’s Licence for Medicinal Products for Human Use

SECTION A: GENERAL INFORMATION

1 DETAILS OF PROPOSED LICENCE HOLDER

1a If Individual:





Name:





Surname:





ID or passport number:





1b If Company:

Name:





Company registration number:





Legal and judicial representative of company:

Name:





Surname:





ID or passport number:





IN001/10 Appendix 1 Version 1

page 1 of 9







Print Form
pageno Next Page


 


Aloaha Software
Aloaha Form Provider Aloaha Crypto Provider Aloaha VallettaCoin