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RTF Template

District Government Muenster

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

1. Authorisation Number	:	DE_NW_MUENSTER_WDA_2018_0001/53.100002_2.40
2. Name of Authorisation Holder	:	Karin Wasielak
3. Address(es) of Site(s)	:	Hansaring 23, Münster, 48155, Germany

4. Legally registered address of Authorisation Holder	:	Industriestraße 5, Senden, 48308, Germany
5. Scope of authorisation (complete for each site under 4)	:	ANNEX 1
6. Legal basis of authorisation	:
7. Name of responsible officer of the competent authority of the member state granting the wholesaling authorisation	:	Confidential, Confidential
8. Signature	:
9. Date	:	2018-01-17
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: Karin Wasielak

, Hansaring 23, Münster, 48155, Germany

1. MEDICINAL PRODUCTS

1.1. with a Marketing Authorisation in EEA country(s)

2. AUTHORISED WHOLESALE DISTRIBUTION OPERATIONS

2.1. Procurement

2.2. Holding

2.3. Supply

Any restrictions or clarifying remarks (for all users): This WDA has been registered for datatechnical reasons by the Bezirksregierung Muenster [District Government of Muenster] in EUDRAGMDP. Issuer of the original document and competent authority is the County Muenster with the responsible officer Jochen Hendrichs. Only for technical reasons the Bezirksregierung Muenster and an
officer of the Bezirksregierung Muenster appear in this electronic entry. Decisive is the original document.

Diese Großhandelserlaubnis ist aus datentechnischen Gründen von der Bezirksregierung Münster in EUDRAGMDP eingetragen worden. Aussteller der Originalurkunde und zuständige Behörde ist die Stadt Münster mit dem ausstellenden Mitarbeiter Jochen Hendrichs. Lediglich aus technischen Gründen erscheint die Bezirksregierung Münster und ein Mitarbeiter der Bezirksregierung Münster in diesem elektronischen Eintrag. Maßgebend ist die Originalurkunde.

*Art 5 of Directive 2001/83/EC or Art 83 of Regulation EC/726/2004

**Without prejudice to further authorisations as may be required according to national legislation

Union Format for a Wholesale Distribution Authorisation	DE_NW_MUENSTER_WDA_2018_0001/53.100002_2.40
	Page 1

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