e-form

Application for a Manufacturer’s / Importer’s Licence for Medicinal Products and / or Investigational Medicinal Products for use in Humans

SECTION A: GENERAL INFORMATION

1 DETAILS OF PROPOSED LICENSE HOLDER



1.1 If Individual:





Name:





Surname:





ID or passport number:





1.2 If Company:

Name:







Company registration number:





Legal and judicial representative of company:

Name:







Surname:





ID or passport number:





IN001/10 Appendix 2 Version 1

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