REQUEST FOR PROPOSAL - EUROPEAN AUTHORIZED REPRESENTATIVEPlease enable JavaScript in your browser to complete this form.1. IMPORTANT INFORMATION - Step 1 of 6Certainly, we will be happy to provide you with a detailed service proposal for European Authorized Representative and allied services. To do so, please provide us with the following information:NEXTManufacturer Name *Address *Address Line 1Address Line 2CityState / Province / RegionPostal Code--- Select country ---AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryWebsite / URLBACKNEXTSERVICE INTRESTED *SelectEuropean Authorized Representative (EAR)European Authorized Representative (EAR) + EUDAMEDEuropean Authorized Representative (EAR) + EU RegistrationEuropean Authorized Representative (EAR) + EU Registration + Free Sale CertificationEuropean Authorized Representative (EAR) + EU Registration + Free Sale Certification + Embassy AttestationEuropean Authorized Representative (EAR) + EU Registration + Free Sale Certification + Embassy & Notary AttestationTechnical Document Review + European Authorized Representative (EAR) + EUDAMEDDrafting Declaration of Conformity + European Authorized Representative (EAR) + EUDAMEDBACKNEXT[01] Device Name *GMDN CodeFind Out: https://www.gmdnagency.org/account/login?ReturnUrl=/Terms/SearchDevice Class *Declaration of conformity (Upload) Click or drag a file to this area to upload. [02] Device NameGMDN Code Device Class Declaration of conformity (Upload) Click or drag a file to this area to upload. [03] Device NameGMDN CodeDevice Class Declaration of conformity (Upload) Click or drag a file to this area to upload. [04] Device NameGMDN CodeDevice ClassDeclaration of conformity (Upload) Click or drag a file to this area to upload. [05] Device NameGMDN CodeDevice ClassDeclaration of conformity (Upload) Click or drag a file to this area to upload. If you have more devices to be covered, please attach separate sheet with above Infomation Click or drag a file to this area to upload. BACKNEXT Current CE Certificate If any? (Upload) Click or drag a file to this area to upload. MDD / IVD Certificates are still valid to register in EU Competent AuthorityBACKNEXTSubmitter Name *Designation / Job Title *Phone *Email *BACKSubmit
