Common use of Listing under the Medical Device Administrative Control System Clause in Contracts

Listing under the Medical Device Administrative Control System. I/ We confirm that: (a) The following medical device(s) under offer is/are already listed under the MDACS with the following details:- Medical device under offer (Manufacturer (Make), Brand and Model) Listing number issued by the DH Validity of the MDACS certificate (From) (To) Device Description under MDACS (b) The following medical device(s) under offer has/have been submitted to the Medical Device Control Office (MDCO) under DH for listing under the MDACS by the following date(s):- Medical device under offer (Manufacturer (Make), Brand and Model) Actual date of submission to DH Application reference number provided by DH (c) The following medical device(s) under offer will be submitted to the Medical Device Control Office (MDCO) under DH for listing under the MDACS by the following date(s):- Medical device under offer (Manufacturer (Make), Brand and Model) Planned date of submission to DH (a date not later than 6 months after commencement of the Validity Period) Name of Seller : Seller’s Chop : Name : Position Held : Signature : E-mail Address : Date : Tel. No: Fax No.:

Listing under the Medical Device Administrative Control System. I/ We confirm that: (a) The following medical device(s) under offer is/are already listed under the MDACS with the following details:- Medical device under offer (Manufacturer (Make), Brand and Model) Listing number issued by the DH Validity of the MDACS certificate (From) (To) Device Description under MDACS (b) The following medical device(s) under offer has/have been submitted to the Medical Device Control Office (MDCO) under DH for listing under the MDACS by the following date(s):- Medical device under offer (Manufacturer (Make), Brand and Model) Actual date of submission to DH Application reference number provided by DH (c) The following medical device(s) under offer will be submitted to the Medical Device Control Office (MDCO) under DH for listing under the MDACS by the following date(s):- Medical device under offer (Manufacturer (Make), Brand and Model) Planned date of submission to DH (a date not later than 6 months after commencement of the Validity Periodcontract commencement) Name of Seller : Name : Authorized Signature : Seller’s Chop : Name : Position Held : Signature : E-mail Address : Date : Tel. No: Fax No.:

Listing under the Medical Device Administrative Control System. I/ We confirm that: (a) The following medical device(s) under offer is/are already listed under the MDACS with the following details:- Medical device under offer (Manufacturer (Make), Brand and Model) Listing number issued by the DH Validity of the MDACS certificate (From) (To) Device Description under MDACS (b) The following medical device(s) under offer has/have been submitted to the Medical Device Control Office Division (MDCOMDD) under DH for listing under the MDACS by the following date(s):- Medical device under offer (Manufacturer (Make), Brand and Model) Actual date of submission to DH (a date not later than 6 months after contract commencement) Application reference number provided by DH (c) The following medical device(s) under offer will be submitted to the Medical Device Control Office Division (MDCOMDD) under DH for listing under the MDACS by the following date(s):- Medical device under offer (Manufacturer (Make), Brand and Model) Planned date of submission to DH (a date not later than 6 months after commencement of the Validity Period) Name of Seller : Name : Authorised Signature : Seller’s Chop : Name : Position Held : Signature : E-mail Address : Date : Tel. No: Fax No.: