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French; bilingual French/English authority masthead — reviewed original Office text

Undated device homologation application form — FORMULAIRE DE DEMANDE D’HOMOLOGATION DES DISPOSITIFS MEDICAUX

Currentness under review. Whether this instrument remains applicable is under review. Consult the later instruments and source context below before relying on it.

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REPUBLIQUE DU CAMEROUN REPUBLIC OF CAMEROON PAIX - TRAVAIL - PATRIE PEACE – WORK - FATHERLAND -------------------- -------------------- MINISTERE DE LA SANTE PUBLIQUE MINISTRY OF PUBLIC HEALTH -------------------- -------------------- SECRETARIAT GENERAL SECRETARIAT GENERAL -------------------- -------------------- DIRECTION DE LA PHARMACIE, DU DEPARTMENT OF PHARMACY, DRUGS MEDICAMENT ET DES LABORATOIRES AND LABORATORIES -------------------- -------------------- FORMULAIRE DE DEMANDE D’HOMOLOGATION DES DISPOSITIFS MEDICAUX Type de demande : Octroi □ Renouvellement □ variation □ N° de dépôt de dossier : Date de dépôt : Désignation du produit :------------------------------------------------------------------------------------------------------ Description du produit :---------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------- Quantité :--------------------------------------------------------------------------------------------------------------------------- Classification :--------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------- Usage du produit:----------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- Adresse complète du fabricant :-------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- Adresse du site de fabrication et du conditionnement :--------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- Adresse complète du demandeur/Futur titulaire :---------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------- Nom et adresse de l’exploitant :--------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------- Nom et adresse du représentant du demandeur au Cameroun :-------------------------------------------------- Nom et adresse du pharmacien (inscrit à l’ordre) interlocuteur au Cameroun :------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------- La durée de vie du produit (en mois) :------------------------------------------------------------------------------------ Site web : http://dpml.cm , http://minsante.cm Tel : (237) 222219281 E-mail : info@dpml.cm

Rendered from the linked Office original — page 1; retained table layout and symbols. This is a render, not an official PDF page.
Rendered from the linked Office original — page 1; retained table layout and symbols. This is a render, not an official PDF page.

Official source for this passage

Le prix grossiste hors taxe du pays d’origine(FCFA) :------------------------------------------------------------------- Le Prix Public du Cameroun(FCFA) :---------------------------------------------------------------------------------------- Fait le, à :--------------------------------------------- Visa : Site web : http://dpml.cm , http://minsante.cm Tel : (237) 222219281 E-mail : info@dpml.cm

Rendered from the linked Office original — page 2; retained table layout and symbols. This is a render, not an official PDF page.
Rendered from the linked Office original — page 2; retained table layout and symbols. This is a render, not an official PDF page.

Official source for this passage