whointernaluseonly.docVIP

WHO Internal Use Only Application Number: Manufacturer identifier number: Product name: Date received at DLT: Manufacturer Information Manufacturer Name of manufacturer WHO manufacturer identification number (MMM) Manufacturer physical address Street Name and No.: City: Postcode: Country: Manufacturer postal address Street Name and No.: Postal Office Box No.: City: Postcode: Country: Manufacturer telephone Manufacturer fax Manufacturer email Manufacturer URL/web address Name of parent company Authorized contacts for the manufacturer Name of key authorized contact Authorized contact postal address Department: Street Name and No.: City: Postcode: Country: Authorized contact telephone Fixed line: Mobile/Cell phone: Authorized contact fax Authorized contact email Name of second authorized contact Authorized contact postal address Department: Street Name and No.: City: Postcode: Country: Authorized contact telephone Fixed line: Mobile/Cell phone: Authorized contact fax Authorized contact email Product - Information Product name and product/catalogue number Product name Provide the product/catalogue number for each product kit size Product/Catalogue number Product kit size (number of tests) If reagents are supplied in more than one box, provide the name or identifier, catalogue/product number, and number of tests for each box of reagents Name or identifier of reagent box Product/Catalogue number Reagent box size (number of tests) Current instructions-for-use Instructions-for-use document number(s) Instructions-for-use version number Instructions-for-use release date List languages available for the Instructions-for-use Current user manual for CD4 Technologies User manual document number User manual version number User manual release date List languag