1. Authorisation Number

:

IV-Р-Т-EU-S-019

2. Name of Authorisation Holder

:

„КАПИТАЛ ФАРМ" ЕООД / "KAPITAL FARM" EOOD

3. Address(es) of Site(s)

:

30 „PESHTERSKO SHOSE" Str., FLOOR VІІ, PLOVDIV, 4002, Bulgaria 

4. Legally registered address of Authorisation Holder

:

УЛ. ПЕЩЕРСКО ШОСЕ № 30, ЕТ. 7, АПТЕЧНО УПРАВЛЕНИЕ/, 30 „PESHTERSKO SHOSE" Str., FLOOR VІІ, ГР. ПЛОВДИВ/PLOVDIV, ОБЩИНА ПЛОВДИВ/PLOVDIV MUNICIPALITY, 4002, Bulgaria

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

:

2013-03-25

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

Name and address of the site: „КАПИТАЛ ФАРМ" ЕООД / "KAPITAL FARM" EOOD

, 30 „PESHTERSKO SHOSE" Str., FLOOR VІІ, PLOVDIV, 4002, Bulgaria   

*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

IV-Р-Т-EU-S-019

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