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REQUEST FOR ISSUANCE OF LOA
Sr. No. 2Particulars Requested Details
1 Name of the Drug Substance :
2 Code of the Drug Substance :
3 Request for
Letter of Authorization / Access :
CEP LoA :
4 DMF version, if available :
5 Pharmacopoeial Grade :
6 Name of the Company :
7 Country of Registration :
8 Name & Address of Marketing Authorization
Holder (MAH)
:
9 Name & Address of MAH Contact Person (if
required in LoA)
:
10 Name & Address of Ministry of Health (MoH) :
11 Name of the MoH Contact Person (if available) :
12 Procedure / Reference Number (if any) :
13 Name of the Product / Formulation Details (to
be mentioned in the LoA)
:

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LoA Request Form.pptx

  • 2. Sr. No. 2Particulars Requested Details 1 Name of the Drug Substance : 2 Code of the Drug Substance : 3 Request for Letter of Authorization / Access : CEP LoA : 4 DMF version, if available : 5 Pharmacopoeial Grade : 6 Name of the Company : 7 Country of Registration : 8 Name & Address of Marketing Authorization Holder (MAH) : 9 Name & Address of MAH Contact Person (if required in LoA) : 10 Name & Address of Ministry of Health (MoH) : 11 Name of the MoH Contact Person (if available) : 12 Procedure / Reference Number (if any) : 13 Name of the Product / Formulation Details (to be mentioned in the LoA) :