Annex -Ia
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□ New notification □ Update of an existing notification |
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(a) Name and address of the maker |
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(b) Purpose of making |
□ Export □ Storing □ Export and storing |
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(c) Member State in which making is to take place and Member State in which first related act (if any) prior to making is to take place |
Member State of making |
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(Member State of first related act (if any)) |
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(d) Number of certificate granted in the Member State of making and number of certificate granted in Member State of first related act (if any) prior to making |
Certificate of Member State of making |
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(Certificate of Member State of first related act (if any)) |
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(e) For medicinal products to be exported to third countries, reference number of marketing authorisation, or the equivalent of such authorisation, in each third country of export |
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