MD - Medical Devices

* All fields are mandatory

Applicant Details

Applicant Name *

Applicant Address *

Country*

State*

District*

City/Taluka/Mandal/Tehsil*

Pincode*

Applicant Occupation:*

Contact Number* (Please include STD Code - Phone Number)

+91

Email *

Medical Details

Pharmacy Name:*

Pharmacy Address:*

Country*

State*

District*

City/Taluka/Mandal/Tehsil*

Pincode*

Purchased date:*

Upload invoice *

download

Submit date:*

Medical Device

Generic Name of Medical Device*

Brand Name (Optional)

Medical Device Grouping Category:*

Notified Category of Medical Device:*

Class of Device*

Sterlization*

Shelf Life :* (In case of Non-Sterilized products,kindly write NIL for shelflife)

Storage Condition:*

Pack Size :*

Product Description*

Reason why the medical device is being submitted for test or evaluation*

Batch Details

Batch Number*

Sample Number(If any)

Quantity Sent*

Quantity Unit*

Manufacturing date:*

Expiry date:*

Remarks*

Fees

Challan Number:*

Challan date:*

Amount:*

Online System for Medical Devices

Form MD-33
[see rule 69]
Application From a Purchaser for test or evaluation of a medical device under section 26 of the Drugs and Cosmetic Act, 1940(23 of 1940)

Applicant Details

Medical Details

Medical Device

Batch Details

Fees

Form MD-33 [see rule 69] Application From a Purchaser for test or evaluation of a medical device under section 26 of the Drugs and Cosmetic Act, 1940(23 of 1940)

Applicant Details

Medical Details

Medical Device

Batch Details

Fees

Form MD-33
[see rule 69]
Application From a Purchaser for test or evaluation of a medical device under section 26 of the Drugs and Cosmetic Act, 1940(23 of 1940)