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Form 12: (See Rule 34) Application For Licence To Import Drugs For Purpose of Examination, Test or Analysis

This document is an application for a license to import drugs for examination, testing, or analysis. It includes information such as the applicant's name and address, the name and address where the testing will be conducted, the name and address where the drugs will be imported from, and the names and quantities of the medical devices to be imported. The applicant agrees to comply with the conditions of the license and confirms a fee was paid under the appropriate account heading.

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1K views1 page

Form 12: (See Rule 34) Application For Licence To Import Drugs For Purpose of Examination, Test or Analysis

This document is an application for a license to import drugs for examination, testing, or analysis. It includes information such as the applicant's name and address, the name and address where the testing will be conducted, the name and address where the drugs will be imported from, and the names and quantities of the medical devices to be imported. The applicant agrees to comply with the conditions of the license and confirms a fee was paid under the appropriate account heading.

Uploaded by

sumit_waghmare
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

FORM 12

(See rule 34)


Application for licence to import drugs for purpose of examination, test or
analysis

I,… …………………………………(Full Name) resident of


………………………………. (Full Address) by occupation………………. hereby
apply for a licence to import the drugs specified below for the purposes of
examination, test or analysis at..............................(Name and address, where
test/analysis is to be carried out) from..........................( Name and address, from
where the medical devices are to be imported) and I undertake to comply with
the conditions applicable to the licence.

A fee of rupees...................... has been credited to Government under the head


of Account “0210-Medical and Public Health, 04-Public Health, 104-Fees and
Fines” under the Drugs and Cosmetics Rules, 1945—Central vide Challan
No…….dated………(attached in original).

Names of Medical Devices and classes Quantities:


of Medical Devices:
1.
2.

Date………. Signature……………..

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