Title: First name: Additional contact person Family name: Contact person's job title Contact person's postal address Unit Building/PO Box number Road/Street Plant/Zone Village/suburb Town/City District and Mandal Province/State Postal code Country Contact person's email address Contact person's phone number Other Introductory information: Related dossiers (e.g. FPP(s) with the same API(s) submitted to the Prequalification Team: medicines (PQTm) by the applicant): API manufacturer Reference API, strength, dosage form Prequalified number (including address if same (eg. Abacavir (as sulphate) 300 (Y/N) (eg HA998) mg tablets) supplier as current dossier) Identify available literature references for the API and FPP:
Additional contact person Title: First name: Family name: Contact person's job title Contact person's postal address Unit Building/PO Box number Road/Street Plant/Zone Village/suburb Town/City District and Mandal Province/State Postal code Country Contact person's email address Contact person's phone number Other Introductory information: Related dossiers (e.g. FPP(s) with the same API(s) submitted to the Prequalification Team: medicines (PQTm) by the applicant): Reference number (eg HA998) Prequalified (Y/N) API, strength, dosage form (eg. Abacavir (as sulphate) 300 mg tablets) API manufacturer (including address if same supplier as current dossier) Identify available literature references for the API and FPP:
82%20Module%202.3%20QOS_Dec2015_1.docx