Reference No:

FORM 9
PRODUCT NAME: MANUFACTURER: MARKETED BY : LAUNCH DATE: PACK INFORMATION: FORMS

COUNTRY:

INDIA
NEW FORM: Yes / No

NDF/NDDB PERIOD:

PRODUCT INFORMATION FORM NEW PRODUCT: Yes / No NEW STRENGTH: Yes / No

ATC: FOR IMS USE ONLY

STRENGTH

VOL/ WT

PACK SIZE

NFC

SMC

FLAGS

PTS

PTR

MRP

THERAPEUTIC INGREDIENTS: EACH CAP CONTAINS

METHOD OF ADMINISTRATION:

(Please specify)

ORAL /INJECTABLE /TOPICAL/OTHERS MANUFACTURER'S INDICATIONS: LITERATURE INCLUDED: Yes / No

SPECIAL COMMENTS (if required)

Name:

Place:

ORG IMS

Period:

Note: Shaded portion is for HO use.

ORG IMS