STATEMENT BY THE RHI The undersigned RHI____________________________(please fill in the name of the RHI and the region it represents) that is currently a Member in ICH commits to withdraw its membership in ICH within two (2) months from the admission of _______________________________(please fill in the name of the individual member of the RHI) as an Observer in ICH. __________________________________ ____________________ Signed by the representative(s) of the RHI Date
STATEMENT BY THE RHI The undersigned RHI____________________________(please fill in the name of the RHI and the region it represents) that is currently a Member in ICH commits to withdraw its membership in ICH within two (2) months from the admission of _______________________________(please fill in the name of the individual member of the RHI) as an Observer in ICH. __________________________________ ____________________ Signed by the representative(s) of the RHI Date
ICH_Observer_Regulatory_Authority_ApplicationForm_2018_0503.docx