Application Form For Registration Of Pharmaceutical Company

Note: This Application Form Is To Be Filled By The Applicant

1. Name Details : *

Address Details :

City : *

Country : *

P. O. Box : *

Postal Code No : *

Fax No.: *

E-Mail : *

Tel. No. : *

Others :

Name And Addresses Of Agents In Other Countries State ( Note : A Copy Of Agency Agreement Certified By The Ministry Of Commerce In The Relevant Country Must Be Attached, If Available .

Agent Name	Country :	Address :
*	*	*
*	*	*
*	*	*
*	*	*
*	*	*
*	*	*

2.Commercial Status :

Governmental : *

Private : *

Stock Co. : *

Others (Specify) :

3.Date Of Establishment : *

4.1 Turnover For The Last 3 Years (Pharmacy Division) :

Year : *

4.2 Registered Capital (Pharmacy Division) : *

4.3 Working Capital (Pharmacy Division) : *

5. Number Of Employees, With Their Qualifications, In The Various Departments Of The Company :


5.1 Research Section :

Qualifications	Number
*	*
*	*
*	*


5.2 Production Section :
Qualifications	Number
*	*
*	*
*	*

5.3 Quality Control Section

Qualifications : *


5.4 Packaging Section :

Qualification	Number
*	*
*	*
*	*

5.5 Others :

Qualifications	Number
*	*
*	*
*	*

I Hereby Certify That, The Information Submitted In This Application Form Is True & Manufactured According To The Good Manufacturing Practices

6- Summary On The Company Activities : *

7. Attached Documents :

Note : A Copy Of The Following Documents Must Be Attached Along With This Application

Note : Additional Documents Can Be Attached Along With This Application

7.1 The Legalized Certificate Of Registration Of The Company As A Manufacturer For Pharmaceutical Products In The Country Of Origin, Attached?

If The Answer Is Yes , Go To The Following Sections (A) And (B):

(A) The Manufacturer License No. Is *

(B) Date Of The First Licensing Is *

7.2 The Statement Of The Affiliated Branches, Attached?

7.3 The List Of The Drugs Manufactured By The Company And Their Respective Retail Prices, Attached?

7.4 The List Of Countries Where The Company's Drugs Are Registered And Marketed , Attached?

7.5 A Letter From The Company Stating That The Drugs To Be Exported To Sudan Are Identical In Their Composition, Specifications, Standards To The Products Sold In The Country Of Origin, And Are Manufactured Under The Same Conditions, Attached?

8. Research & Development Details : *

The Brief Report On Research & Development Activities Including:

(A) The Date Of Establishment : *

(B) Photocopies Of The Published Articles & References Showing The Products Innovated By The Company, Attached?

I Hereby Certify That, The Information Submitted In This Application Form Is True & Manufactured According To The Good Manufacturing Practices

The Manufacturer : *

Name Of Authorized Person In The Company : *

Title : *

Signature : *