1964_PHARMACY_AND_POISONS_REGULATIONS — Page 67

1987 Ed.]

Pharmacy and Poisons Regulations

[CAP. 138

A 67

FORM 5

表格五

[Subsidiary]

[reg.29(6).]

L.N. 137/78.

〔規例第二九條第(六)款〕

PHARMACY AND POISONS ORDINANCE 藥劑及毒藥條例

(Chapter 138)

(香港法例第一三八章)

FREE SALE CERTIFICATE OF PHARMACEUTICAL PRODUCT

藥劑製品自由售賣證明書

Name and dosage form of product:

製品名稱及藥劑形式(註明劑量單位):

Name and amount of each active ingredient:

每一有效藥料之名稱及份量:

Manufacturer, and/or when applicable, the person responsible for placing the 製造商

雙

及/ 或(如適用)負責將該製品在市 product on the market:

場銷售之人士:

Address(es):

地址:

It is certified that:

茲證明:

* This product has been authorized to be placed on the market for use in

上 述製品經獲准在香港市場銷售,以供

Hong Kong.

使用。

Number of permit and date of issue

許可證編號及簽發日期:

* This product has not been authorized to be placed on the market for use

上述製品不獲准在香港市場銷售

in Hong Kong for the following reasons:

使用。理由如下:

»

It is also certified that (a) the manufacturing plant in which the product is 玆並 並證明 ( 甲 > 上述製品 之製造廠, 每 produced is subject to inspection at suitable intervals, and (b) the manufacturer 隔適當時間即受檢查 、及(乙)製造商對於 conforms to requirements for good practices in the manufacture and quality 在原產國家內推銷或發行或供出口之製品 control, as recommended by the World Health Organization, in respect of products 已依照世界衛生組織之建議 ,在製造及品 to be sold or distributed within the country of origin or to be exported.

質管制方面,遵循其所規定之良好習慣

HONG KONG.

香港

(Date)

日期:

藥劑業及毒藥管理局

代行

for Pharmacy and Poisons Board.