WHOCC
Postal address:
WHO Collaborating Centre for Drug Statistics Methodology
Norwegian Institute of Public Health
P.O.Box 4404 Nydalen
0403 Oslo
Norway

Visiting/delivery address:
Marcus Thranes gate 6
0473 Oslo
Norway

Tel:  +47 21 07 81 60
Fax: +47 21 07 81 46
E-mail:
 
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Application form

Print version


Requested by

Name:
Company:  
Address:
Country:
Email:

Active ingredients (preferably INN names):
INN request number:
Brand name:
Dosage form:
Strengths:
Manufacturer:
Main indication*:
Other indications*: * References should be given and submitted (e.g. from SPC)
Approved dose recommendations*: 
ATC code proposal:  
DDD proposal:  


Status concerning Marketing Authorization

Marketing Authorization (MA) has been approved in the following countries1)2):

Date of approval:  

MA application has been submitted in the following countries2):  

Date of submission:  

 A MA application has not yet been submitted, but is planned , in the following countries:

1) If the indication(s) in any country differ from those given in the application form, please describe these differences in a separate enclosure.
2) Please indicate type of application (e.g. National, Centralised Procedure, etc)

Documentation and references (e.g SPC/Prescribing information), in English only, should be uploaded on the next page. Please note that no paper copies are required when the application is submitted electronically followed by our automatic receipt. Application for ATC/DDD is free of charge.

Last updated: 2011-01-04