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RTF Template

Government of Upper Franconia

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

1. Authorisation Number	:	ROF-SG55.2-2675.3-90-1-12
2. Name of Authorisation Holder	:	Sico Dentaldepot GmbH
3. Address(es) of Site(s)	:	Industriestraße 13, Hirschaid, 96114, Germany

4. Legally registered address of Authorisation Holder	:	Industriestraße 13, Hirschaid, 96114, 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	:	2016-12-01
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: Sico Dentaldepot GmbH

, Industriestraße 13, Hirschaid, 96114, Germany

1. MEDICINAL PRODUCTS

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

2. AUTHORISED WHOLESALE DISTRIBUTION OPERATIONS

2.1. Procurement

Any restrictions or clarifying remarks (for all users): The scope of wholesale trade consists of drop shipment of disinfectants and finished pharmaceuticals for the needs of dentists and oral and maxillofacial surgeons.

Der Umfang des Großhandels besteht im Streckengeschäft mit Desinfektionsmitteln und Fertigarzneimitteln für den Bedarf bei Zahnärzten und Mund-, Kiefer- und Gesichtschirurgen.

*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	ROF-SG55.2-2675.3-90-1-12
	Page 1

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