e-form

Application for a Variation to a Licence issued in accordance with the
Production of Cannabis for Medicinal and Research Purposes Act
(Chapter 578 of the Laws of Malta)

Licence holder name:





Licence holder address:





Site Name/ Number:





Street:





Locality:





Postcode:





Number of Licence being varied:





Contact name:





Telephone number:

Mobile number:

E-mail address:

CAN002-03 Appendix VIII Version 01

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