REQUEST FOR PROPOSAL - EUROPEAN AUTHORIZED REPRESENTATIVE

Kindly submit the particular information requested below to receive a detailed service proposal European Authorized Representative and allied service.

MANUFACTURER INFORMATION

Legal Manufacturer / OEM / OBL Name *:
Street *:
City / Pincode *:
Country *:
Website Address :

SERVICE REQUEST

SERVICE INTRESTED :
NUMBER OF MEDICAL DEVICES[ ? ]:

MEDICAL DEVICE INFORMATION

[01] Name of the Medical Device *:
GMDN Code * [Find Out ]:
Device Class * :
Declaration of confirmity (Upload) :
[02] Name of the Medical Device:
GMDN Code:
Device Class :
Declaration of confirmity (Upload) :
[03] Name of the Medical Device:
GMDN Code:
Device Class :
Declaration of confirmity (Upload) :
[04] Name of the Medical Device:
GMDN Code:
Device Class :
Declaration of confirmity (Upload) :
[05] Name of the Medical Device:
GMDN Code:
Device Class :
Declaration of confirmity (Upload) :
CE Certificate (Upload) :


SUBMITTER INFORMATION

Contact Person * :

Job Title * :

Contact Number *:

Contact Email *: