US FDA DMF - Request For Quote Please fill the below form and submit online. 1. GENERAL INFORMATION 1.1) Name of the Company : 1.2) Contact Person : Mr Mrs Dr Prof Ms 1.3) Job Title : 1.4) Contact Number : 1.5) Contact Email : 1.6) Website Address : 2. MANUFACTURER INFORMATION 2.1) Name of the product : 2.2) Intended use of the product : 2.3) End user of this product : The intended use should be based on the expected uses of the product by the end user or consumer. 2.4) Do you have variants/Types? Yes No 2.5) List the variants/Types : 2.6) Write the major difference between the variants/Types : 2.7) Do you want all the variants to be included in the same DMF? Yes No 3. ADMINISTRATIVE INFORMATION 3.1) Preparation of DMF : Yes No 3.2) US Agent service : Yes No 3.3) Attach the photograph of the product : 3.4) Upload product brochure/ manual / Specification/ IFU : 3.5) Information provided by : Mr Mrs Dr Prof Ms 3.6) Date : Receive copy of the filled RFQ, Please provide email ID :
