1964_PHARMACY_AND_POISONS_REGULATIONS — Page 75

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1987 Ed.]

Pharmacy and Poisons Regulations

[CAP. 138

A 75

[Subsidiary]

FORM 13

[reg. 37A.]

L.N. 369/80.

PHARMACY AND POISONS ORDINANCE

(Chapter 138)

APPLICATION FOR REGISTRATION AS AN IMPORTER/EXPORTER OF PHARMACEUTICAL PRODUCTS

We wish to apply for registration as an importer and exporter of pharmaceutical products under the Pharmacy and Poisons Ordinance, Cap. 138.

Name of pharmaceutical product(s) registered by Applicant:

Name of manufacturer(s) represented by Applicant, if any:

Description of storage room/cubicle/receptacle*: (* Delete as appropriate)

Name of Applicant:

Business Address of Applicant:

Name of person in charge:

Tel. No.

Date

Signature

表格十三

〔規例第三十七A條〕

藥劑及毒藥條例

(香港法例第一三八章)

藥劑製品進/出口商註冊申請書

茲根據香港法例第一三八章藥劑及毒藥條例之規定申請註冊為藥劑製品進出口商

申請人之註冊藥劑製品名稱:

申請人所代表之製造商名稱(如有代表):

* 貯藏室/間隔/容器說明:

(* 將不適用者刪去)

申請人姓名:

申請人營業地址:

電話號碼:

主管人姓名:

日期:

簽署:

Page 75

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1987 Ed.] Pharmacy and Poisons Regulations [CAP. 138 A 75 [Subsidiary] FORM 13 [reg. 37A.] L.N. 369/80. PHARMACY AND POISONS ORDINANCE (Chapter 138) APPLICATION FOR REGISTRATION AS AN IMPORTER/EXPORTER OF PHARMACEUTICAL PRODUCTS We wish to apply for registration as an importer and exporter of pharmaceutical products under the Pharmacy and Poisons Ordinance, Cap. 138. Name of pharmaceutical product(s) registered by Applicant: Name of manufacturer(s) represented by Applicant, if any: Description of storage room/cubicle/receptacle*: (* Delete as appropriate) Name of Applicant: Business Address of Applicant: Name of person in charge: Tel. No. Date Signature 表格十三〔規例第三十七A條〕藥劑及毒藥條例 (香港法例第一三八章) 藥劑製品進/出口商註冊申請書茲根據香港法例第一三八章藥劑及毒藥條例之規定申請註冊為藥劑製品進出口商申請人之註冊藥劑製品名稱: 申請人所代表之製造商名稱(如有代表): * 貯藏室/間隔/容器說明: (* 將不適用者刪去) 申請人姓名: 申請人營業地址: 電話號碼: 主管人姓名: 日期: 簽署: Page 75 Page 76

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1987 Ed.] Pharmacy and Poisons Regulations [CAP. 138 A 75 [Subsidiary] FORM 13 [reg. 37A.] L.N. 369/80. PHARMACY AND POISONS ORDINANCE (Chapter 138) APPLICATION FOR REGISTRATION AS AN IMPORTER/EXPORTER OF PHARMACEUTICAL PRODUCTS We wish to apply for registration as an importer and exporter of pharma- ceutical products under the Pharmacy and Poisons Ordinance, Cap. 138. Name of pharmaceutical product(s) registered by Applicant: Name of manufacturer(s) represented by Applicant, if any: Description of storage room/cubicle/receptacle*: (* Delete as appropriate) Name of Applicant: Business Address of Applicant: Name of person in charge: Tel. No. Date Signature 表格十三〔規例第三十七A條) 藥劑及毒藥條例 (香港法例第一三八章) 藥劑製品進/出口商註冊申請書兹根據香港法例第一三八章藥劑及毒藥條例之規定申請註冊為藥劑製品進出口申請人之註冊藥劑製品名稱: 申請人所代表之製造商名稱(如有代表): * 貯藏室/間隔/容器說明: (* 將不適用者删去) 申請人姓名: 申請人營業地址: 電話號碼: 主管人姓名: 日期: 簽署: Page 75Page 76

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