EUROPEAN DIRECTORATE FOR THE QUALITY OF MEDICINES & HEALTHCARE

0 EN EUROPEAN ECONOMIC AND SOCIAL COMMITTEE
29 THE SCOPE FOR ACTION OF EUROPEAN PARLIAMENT
3 EUROPEAN ECONOMIC AND SOCIAL COMMITTEE SPEAKING

Е ВРОПЕЙСКИЙ ПРОЕКТ НПМ COUNCIL OF EUROPE EUROPEAN
EUROPEAN COURT OF HUMAN RIGHTS JUDGMENTS ON THE
EUROPEAN CURRICULUM VITAE FORMAT PERSONAL INFORMATION IEVA GRUNDSTEINE

Form to be filled in for each application for a Certificate of Suitability to the monographs of the European Pharmacopoeia in a


European Directorate for the Quality of Medicines & HealthCare

Certification of Substances Department


CHANGE OF CONTACT DETAILS
FOR A CERTIFICATE OF SUITABILITY





Date of notification: ……./……/……



1. General Information

Dossier number and substance

CEP …………………………/ [Substance name] …………………………

Subtitle (if applicable) .…………………………

In case the change concerns several CEPs, please list the dossier numbers and substances here:

CEP …………………………/ [Substance name] …………………………



2. Details of contact person authorised for communication on behalf of the holder:


(if contact is part of a company/group different from holder please provide an authorisation letter - see Annex 1):


Title* (Mrs, Mr, Dr)


First name*


Family name*


Job title/Department


Name of the company*


Address for correspondence*


Postcode*


Town*


Country*


Telephone*


E-mail*


Fields marked * are mandatory





Annex 1



Template letter of Authorisation


address of the holder


date and place


LETTER OF AUTHORISATION



We, name of the holder, hereby authorise, name of the authorised representative, to act as official representative for our Certificate of Suitability for name of the substance.



Signature






Page 2/2 FORM/577 – Rev. 02


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