1964_PHARMACY_AND_POISONS_REGULATIONS — Page 68

HK Historical Laws 香港歷史法例 All AI Reviewed

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A 68

[Subsidiary]

L.N.137/78.

CAP. 138]

Pharmacy and Poisons Regulations

[1987 Ed.

FORM 6

[reg. 36(2).]

表格六

〔規例第三六條第(二)款〕

PHARMACY AND POISONS ORDINANCE

藥劑及毒藥條例

(Chapter 138)

(香港法例第一三八章)

APPLICATION FOR REGISTRATION OF A DRUG/
PHARMACEUTICAL PRODUCT/SUBSTANCE

藥物/藥劑製品/物質註冊申請書

Note: A specimen sales pack of the drug/product or sample of the substance and the relevant literature must be submitted together with the application. Supplementary documentation and supporting documents issued by the health authority in the Country of origin should be submitted if required.

註意:申請書須連同下述藥物/製品之出售包裝樣本或物質樣本及有關之說明書—併呈遞。如有需要,原產國家之衛生當局所簽發之輔助性文件及證明文件亦須附呈。

Name of Drug/Product/Substance*:
(*Delete as appropriate)

*藥物/製品/物質名稱:
(*將不適用者刪去)

Dose Form/Package Size(s):

藥劑形式(註明劑量單位)/包裝:

Detailed Qualitative and Quantitative Composition:

性質及份量組合詳情:

量

Indications:

適應症:

Names of Countries in which registered/marketed:

在何國家登記/銷售:

Name of Applicant:

申請人姓名:

Business Address of Applicant:

申請人營業地址:

Name of Manufacturer:

製造商名稱:

Address of Manufacturer:

製造商地址:

Tel. No.

電話號碼:

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A 68 [Subsidiary] L.N.137/78. CAP. 138] Pharmacy and Poisons Regulations [1987 Ed. FORM 6 [reg. 36(2).] 表格六〔規例第三六條第(二)款〕 PHARMACY AND POISONS ORDINANCE 藥劑及毒藥條例 (Chapter 138) (香港法例第一三八章) APPLICATION FOR REGISTRATION OF A DRUG/PHARMACEUTICAL PRODUCT/SUBSTANCE 藥物/藥劑製品/物質註冊申請書 Note: A specimen sales pack of the drug/product or sample of the substance and the relevant literature must be submitted together with the application. Supplementary documentation and supporting documents issued by the health authority in the Country of origin should be submitted if required. 註意:申請書須連同下述藥物/製品之出售包裝樣本或物質樣本及有關之說明書—併呈遞。如有需要,原產國家之衛生當局所簽發之輔助性文件及證明文件亦須附呈。 Name of Drug/Product/Substance*:(*Delete as appropriate) *藥物/製品/物質名稱:(*將不適用者刪去) Dose Form/Package Size(s): 藥劑形式(註明劑量單位)/包裝: Detailed Qualitative and Quantitative Composition: 性質及份量組合詳情: 量 Indications: 適應症: Names of Countries in which registered/marketed: 在何國家登記/銷售: Name of Applicant: 申請人姓名: Business Address of Applicant: 申請人營業地址: Name of Manufacturer: 製造商名稱: Address of Manufacturer: 製造商地址: Tel. No. 電話號碼:

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A 68 [Subsidiary] L.N.137/78. CAP. 138] Pharmacy and Poisons Regulations [1987 Ed. FORM 6 [reg. 36(2).] 表格六〔規例第三六條第(二)款】 PHARMACY AND POISONS ORDINANCE 藥劑及毒藥條例 (Chapter 138) (香港法例第一三八章) APPLICATION FOR REGISTRATION OF A DRUG/ PHARMACEUTICAL PRODUCT/SUBSTANCE 藥物/藥劑製品/物質註冊申請書 Note: A specimen sales pack of the drug/product or sample of the substance and the relevant literature must be submitted together with the application. Supplementary documentation and supporting documents issued by the health authority in the Country of origin should be submitted if required. 註意:申請書須連同下述藥物/製品之出售包裝樣本或物質樣本及有關之說明書-- 併呈遞。如有需要,原產國家之衛生當局所簽發之輔助性文件及證明文件亦須附品。 Name of Drug/Product/Substance*: (*Delete as appropriate) *藥物/製品/物質名稱: (*將不適用者删去) Dose Form/Package Size(s): 藥劑形式(註明劑量單位)/包裝: Detailed Qualitative and Quantitative Composition: 性質及份量組合詳情: 量 Indications: 適應症: Names of Countries in which registered/marketed: 在何國家登記/銷售: Name of Applicant: 申請人姓名: Business Address of Applicant: 申請人營業地址: Name of Manufacturer: 製造商名稱: Address of Manufacturer: 製造商地址: Tel. No. 電話號碼:

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