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Drug Master File (DMF) Application Form
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(PDF Version - 26 K)
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(Word Perfect Version - 37 K)Contact: Drug Master File Enquiries
Drug Master File (DMF) Name:
DMF Number (if issued):
Customer / Client Number (if issued):
DMF Type:
Contact Information of Drug Master File (DMF) Owner
(Required)
Name:
Title:
Company Name:
Mailing Address:
E-mail:
Phone Number:
Fax Number:
Contact Information of Drug Master File (DMF) Agent
(if applicable)
Name:
Title:
Company Name:
Mailing Address:
E-mail:
Phone Number:
Fax Number:
I, the undersigned, certify that the information and material included in this Drug Master File application is accurate and completeFootnote 1
Name of Authorized Signing Official
Signature
Date (YYYY-MM-DD)
Footnotes
- Footnote 1
-
If the signing official is a third party acting on behalf of the Drug Master File (DMF) Owner, an agent letter of authorization signed by the DMF Owner must be filed with the completed application form.
