Third Party Information To be completed by proposed Designated Individual for each third party agreement. Third party organisation Name: name Address of third party Address: premises where activity/ies take place Postcode: Name of third party contact Job title Employing body or organisation Telephone Is there an agreement in Yes No place with the third party? What was the start date of the agreement? Does the agreement have an end date? How often is the agreement reviewed? Activity/ies relating to Procurement tissues and/or cells for human application which Testing are taking place under the third party Processing agreement Distribution Export Is the establishment Yes No licensed by the Human Tissue Authority for the If yes, please state the Human Tissue Authority licensing activity/ies it carries out number and do not answer the accreditation questions below. on your establishment’s behalf? Licensing number: If no, please answer the accreditation questions below. Does the third party who Procurement is carrying out the activity/ies on behalf of accreditation Yes No the establishment have
Third Party Information To be completed by proposed Designated Individual for each third party agreement. Third party organisation name Name: Address of third party premises where activity/ies take place Address: Postcode: Name of third party contact Job title Employing body or organisation Telephone Is there an agreement in place with the third party? Yes No What was the start date of the agreement? Does the agreement have an end date? How often is the agreement reviewed? Activity/ies relating to tissues and/or cells for human application which are taking place under the third party agreement Procurement Testing Processing Distribution Export Is the establishment licensed by the Human Tissue Authority for the activity/ies it carries out on your establishment’s behalf? Yes No If yes, please state the Human Tissue Authority licensing number and do not answer the accreditation questions below. Licensing number: If no, please answer the accreditation questions below. Does the third party who is carrying out the activity/ies on behalf of the establishment have Procurement accreditation Yes No
TPA%20submission%20form%202018.docx