REQUEST FOR PROPOSAL – CLINICAL EVALUATION REPORT DOCUMENTATIONPlease enable JavaScript in your browser to complete this form.1. IMPORTANT INFORMATION - Step 1 of 6 The organization should appoint experts and writers for developing a fully complied clinical evaluation report. The filled form helps us get more details about medical devices and manufacturers. Fill out separate forms for each device.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 / URLBACKNEXTNotified Body Selected / Interested?SelectNot SelectedNB 2265-3ECNB 2797-BSINB 2409-CERTISONB 0546-CERTIQUALITYNB 1912-DARENB 0344/NB 0124-DERKANB 2460-DNVNB 0297-DQSNB 0537/0477-EUROFINSNB 0459-GMEDNB 0051-IMQNB 0373-ISDINB 2862-INTERTEKNB 0476-KIWANB 0483-MDCNB 0482-MEDCERTNB 0050-NSAINB 0598-SGSNB 2460-DNVNB 0123-TUV SUDNB 2696-UDEMOthersScope of Work (CER Writer / Consultant)SelectCER Documentation + PMS, PMCF, PSUR, RMF with NB CoordinationCER Documentation + PMS, PMCF, PSUR, RMF without NB CoordinationCER DocumentationDedicated team / Person to coordinate with consultants?YesNoWill appoint SoonStatus of EU 2017/745 Technical DocumentationSelectUnder DevelopmentChangeover from MDD is in progressCompleted as per EU 2017/745Will start soonBACKNEXTName of the Medical Device *Intended Use of the Device *What is the purpose of this device?Indications of UseMedical conditions with which the device can be used for..Intended Users *Whom can make use of this device?Target Population *Who is ultimately getting clinically benefited upon using this deviceDevice Variants to be considered in the CER *SelectONETWO1-51-10Number of Accessories part of the main device *SelectNilONETWO1-51-10Name the accessoriesNumber of components part of the main device *SelectNilONETWO1-51-10As per MDR accessories has to be considered in its own right. Name the Components BACKNEXTClass of Device as per MDR *SelectClass 1Class 1 SterileClass 1 MeasuringClass 1 ReusableClass 11 aClass 11 bClass 111Device Body ContactSelectExternal Body ContactNo Body ContactLimited (< 24h)Prolonged (24h to 30 days)Long Term (> 30 days)Device Invasive action bySelectNot ApplicableWith the help of surgical procedureBody orificeTotally introduced into the body through surgical procedurePartially introduced into the body through surgical procedureBACKNEXTSubmitter Name *Designation / Job Title *Phone *Email *BACKSubmit