Name and address (of the QP countersigning, if applicable) Professional body____________________________________________________________ Membership number and designatory letters_______________________________________ Length of service on the relevant Authorisation(s) __________________________ Manufacturer’s Countersignature Date
Name and address (of the QP countersigning, if applicable) Professional body____________________________________________________________ Membership number and designatory letters_______________________________________ Length of service on the relevant Manufacturer’s Authorisation(s) __________________________ Countersignature Date
QP_Sponsor_Form_2018.docx