cepapplicationform cep证书申请表

Application FormREQUEST FOR NEW CERTIFICATE OF SUITABILITY(to be filled in for each request for a ne

European Directorate for the Quality of Medicines &HealthCare Certification of Substances Division Application Form REQUEST FOR NEW CERTIFICATE OF SUITABILITY (to be filled in for each request for anew Certificate of Suitability to the monographs of the European Pharmacopoeia, in accordance with Resolution AP-CSP (07) 1) Date of submission: ……./……/…… Format of submission (select one only): eCTDNeeS PDF Paper 1. General Information: 1.1.Type of application for anew Certificate of Suitability: (Please tick the appropriate option-select one only) ChemicalChemical and sterileTSE Double (Chemical and TSE)Double and sterileHerbal 1.2Name of the substance using the Recommended International Nonproprietary Specify any subtitle requested such as 'sterile', 'micronized': Name (rINN). 1.3 Monograph(s) you are referring to: Name, Number, Year of publication () Page 1/ 28 FORM/055 –Rev. 07 [19/11/2012]