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RTF Template

Government of Upper Franconia

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

1. Authorisation Number	:	ROF-SG55.2-2675.3-24-3-17
2. Name of Authorisation Holder	:	Dr. Schittenhelm Pharma GmbH & Co. KG
3. Address(es) of Site(s)	:	Goethestraße 17, Nürnberg, 90409, Germany

4. Legally registered address of Authorisation Holder	:	Goethestraße 17, Nürnberg, 90409, Germany
5. Scope of authorisation	:	ANNEX 1
6. Legal basis of authorisation	:
7. Name of responsible officer of the competent authority of the member state granting the wholesale distribution authorisation	:	Confidential, Confidential
8. Signature	:
9. Date	:	2016-12-09
10. Annexes attached	:	Annex 1 Scope of wholesale distribution authorisation Annex 2 (Optional) Address(es) of contract wholesale distribution sites and their authorisation number Annex 3 (Optional) Name(s) of responsible person(s) Annex 4 (Optional) Date of Inspection on which authorisation was granted Annex 5 (Optional) Additional provisions based on national requirements

ANNEX 1

SCOPE OF WHOLESALE DISTRIBUTION AUTHORISATION

Name and address of the site: Dr. Schittenhelm Pharma GmbH & Co. KG

, Goethestraße 17, Nürnberg, 90409, Germany

2. AUTHORISED WHOLESALE DISTRIBUTION OPERATIONS

2.5. Other activities(s): Trade with medicinal products by drop shipmentHandel mit Arzneimitteln im Streckengeschäft

Any restrictions or clarifying remarks (for all users): Only trade by drop shipment, no holding, authorisation does not include transport

Ausschließlich Handel im Streckengeschäft, keine Lagerung, Erlaubnis umfasst nicht den Transport

Union Format for a Wholesale Distribution Authorisation	ROF-SG55.2-2675.3-24-3-17
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