[PDF] [PDF] DELEGATION OF POWER - AFMPS

[PDF] POWER OF ATTORNEY

Registered Office: Avenue Louise 81, 1050 Brussels, Belgium, VAT: BE830 597 835 HEREBY GIVE POWER OF ATTORNEY TO: Attorney n° 1[Last name,  

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[PDF] DELEGATION OF POWER - AFMPS

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DELEGATION OF POWERS

The Company, .......................................... having its registered office at ........................................................., duly represented by ...................................., hereby appoints as its special attorney :...................................................... ............................................. to whom it grants full powers in order to carry out all acts,,sign all documents, receive all correspondence from the Belgian Federal Agency for Medicines and Health Products and use all necessary means in order to obtain or hold marketing authorisations granted in accordan ce with article 6 of the Belgian Law of March 25 th , 1964, and for [name of the medicinal product(s) concerned], and to whom it grants full powers of representation towards the Belgian Federal Agency for Medicines and Health Products for all useful or necessary purposes in relation to the pharmaceutical regulations applicable in Belgium. This contract is governed by the laws of Belgium and any dispute arising under or in connection with the agreement shall be subject to the e xclusive jurisdiction of the

Belgian courts.

The present delegation of powers can be revoked at all times by simple decision of the company. This decision must be communicated to the Federal Agency for Medicines and Health Products.

This agreement has

been notorised/legalised by a notary and will enter into force as from ...

Drawn up for all legal purposes.

Done at ....................., on .....................................,

Signature(s)

Seal(s)

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