jh gcahlbias Thereby declare that all the above information is correct and accurate, and all the required documents will be submitted within ONE month starting from the date of receiving the form, and I am fully aware of the consequences of the non-compliancejl 6c GblAi asp Ammar Optician Company 4ubil Glacoll g djcmaill aus Medical Devices & Equipment Section to the time frame set. And 1 will inform company of any difficulties to implement the action required. Signature Authorized Person ~~ = CPR Number Date