Sample Receipt Forms Sample Clauses

Sample Receipt Forms. Each Impax PSR shall complete a Sample Receipt Form with respect to each Sample disbursed by such Impax PSR. In each instance where a Sample is disbursed, the Impax PSR providing such Sample shall ensure that the Neurologist receiving such Sample signs the applicable Sample Receipt Form in acknowledgment of receipt of such Sample. Each Impax PSR shall mail to Impax or Impax’s Permitted Subcontractor (as determined by Impax), in pre-addressed, postage-paid envelopes provided by Impax, or send via electronic means, on a regular basis no less frequently than quarterly the original completed Sample Receipt Forms for Sample disbursements performed by such Impax PSR during the period covered by the report. A copy of all such Sample Receipt Forms shall be kept by Impax or its Permitted Subcontractor. Impax shall ensure that each Impax PSR fills out the Sample Receipt Forms accurately, completely and timely. For the avoidance of doubt, the foregoing obligations are in addition to the procedures set forth in Article 10.
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Sample Receipt Forms. Sample Receipt Forms utilized by Impax for distribution of Samples under this Agreement shall contain the following information: • Sample Receipt Number • PSR ID Number • PSR Name • Sales Territory Number • Call Date • Prescriber Information • Name [Last, First, Middle Initial] • Address • Professional Designation [MD, DO, NP, PA, Other (specify)] • State License Number • Product Information • Product Name [e.g., XXXXX] • Dosage Strength/Package Size [e.g., 50mg (1 x 7)] • NDC Number [e.g., 1211-40] • Manufacturing Lot Number • Quantity distributed • Practioner Signature • PSR Signature • The following disclosure language immediately under the Practioner Signature: • “By signing, I certify: I am a licensed practitioner and can legally prescribe in my state; if my authority is dependent, I have a current collaborative agreement that includes the samples requested. I am requesting samples so I may evaluate the efficacy & tolerability in an appropriate patient. These samples will not be traded, sold, offered for sale, bartered, or returned for credit, nor be submitted to any public or private third-party payor for reimbursement. This is my personal signature.” SCHEDULE 1.94 Wyeth Sales Training Program for the Initial Product Initial Training - XXXXX. POA Training - XXXXX. New Hire Training - XXXXX. Exhibit A to Schedule 1.94 Delivery Method* Training Catalog (Learning Material Activity Learning Activity Name Category Subcategory Time) Location* þ Course: XXXXX XXXXX XXXXX XXXXX XXXXX Course: XXXXX XXXXX XXXXX XXXXX XXXXX Course: XXXXX XXXXX XXXXX XXXXX XXXXX Course: XXXXX XXXXX XXXXX XXXXX XXXXX Exam: XXXXX XXXXX XXXXX XXXXX XXXXX Course: XXXXX XXXXX XXXXX XXXXX XXXXX Course: XXXXX XXXXX XXXXX XXXXX XXXXX Course: XXXXX XXXXX XXXXX XXXXX XXXXX Exam: XXXXX XXXXX XXXXX XXXXX XXXXX Course: XXXXX XXXXX XXXXX XXXXX XXXXX Course: XXXXX XXXXX XXXXX XXXXX XXXXX Course: XXXXX XXXXX XXXXX XXXXX XXXXX Course: XXXXX XXXXX XXXXX XXXXX XXXXX Course: XXXXX XXXXX XXXXX XXXXX XXXXX Course: XXXXX XXXXX XXXXX XXXXX XXXXX Exam: XXXXX XXXXX XXXXX XXXXX XXXXX Course: XXXXX XXXXX XXXXX XXXXX XXXXX Course: XXXXX XXXXX XXXXX XXXXX XXXXX Exam: XXXXX XXXXX XXXXX XXXXX XXXXX Course: XXXXX XXXXX XXXXX XXXXX XXXXX Course: XXXXX XXXXX XXXXX XXXXX XXXXX Exam: XXXXX XXXXX XXXXX XXXXX XXXXX SCHEDULE 3.4 Sample Calculation of Incentive Fee Market Share Contract Year 1 Contract Year 2 Change Total Prescriptions in XXXXX Category (All Prescribers) XXXXX XXXXX XXXXX TRx — All Prescribers XXXXX XX...
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Sample Receipt Forms. Sample Receipt Forms utilized by Impax for distribution of Samples under this Agreement shall contain the following information: XXXXX SCHEDULE 1.94 Wyeth Sales Training Program for the Initial Product XXXXX. Exhibit A to Schedule 1.94 XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX þ XXXXX: XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX: XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX: XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX: XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX: XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX: XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX: XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX: XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX: XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX: XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX: XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX: XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX: XXXXX XXXXX XXXXX XXXXX XXXXX: XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX: XXXXX XXXXX XXXXX XXXXX XXXXX: XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX: XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX: XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX SCHEDULE 3.4 Sample Calculation of Incentive Fee XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX % XXXXX % XXXXX % XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX % XXXXX % XXXXX % XXXXX XXXXX XXXXX XXXXX XXXXX $ XXXXX XXXXX XXXXX XXXXX $ XXXXX XXXXX $ XXXXX XXXXX $ XXXXX XXXXX XXXXX 3 Confidential SCHEDULE 6.4.6 Wyeth Form 1747(b) SEE ATTACHED XXXXX 5 Confidential SCHEDULE 6.6 Wyeth Form 8202 SEE ATTACHED XXXXX 14 SCHEDULE 7.3 Initial Product Patents U.S. Patent XXXXX U.S. Patent XXXXX
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Related to Sample Receipt Forms

  • Spreadsheet The Company shall prepare and deliver to Buyer and the Sellers’ Representative, at or prior to the Closing, a spreadsheet (the “Spreadsheet”) in the form reasonably acceptable to Buyer, which Spreadsheet shall be dated as of the Closing Date and shall set forth all of the following information (in addition to the other required data and information specified therein), as of the Closing Date and immediately prior to the Closing: (a) the names of all the Company Stockholders, Company Optionholders and their respective email addresses , Israeli identification number (and where available, taxpayer identification numbers) and bank account details (including the respective bank name and number, branch name and address, swift number and account number); (b) whether such Person is or was an employee of the Company or the US Subsidiary; (c) the number and kind of shares of Company Capital Stock held by, or subject to the Company Options held by such Persons and, in the case of outstanding certificated shares, the respective certificate numbers; (d) the number of shares of Company Capital Stock subject to and the exercise price per share, as converted to US dollars ($) per the NIS Exchange Rate, in effect for each Company Option; (e) the vesting status and schedule with respect to the Company Options and Company Capital Stock and terms of the Company’s rights to repurchase such unvested Company Capital Stock (including the repurchase price payable per share under each share of unvested Company Capital Stock); (f) the Tax status of each share of Company Capital Stock and Company Option under Section 422 of the Code or, if applicable, under the Israeli Tax Code (including status as a Company 102 Share, Company 102 Option or Company 3(i) Option); (g) the Aggregate Consideration Value, the Company Net Working Capital, the Transaction Expenses that are unpaid as of the Closing, the Buyer Stock Price Per Share, the Fully-Diluted Company Capital Stock Amount, the Aggregate Seller Company Capital Stock Amount, the Founder Seller Company Capital Stock Amount, the Non-Founder Seller Company Capital Stock Amount, the Founder Seller Pro-Rata Share and the Non-Founder Seller Pro-Rata Share; (h) the calculation of the Aggregate Net Consideration Amount, the Equity Exchange Ratio, the NIS Exchange Rate, the Aggregate Founder Seller Cash Amount, the Aggregate Founder Seller Stock Amount, the Aggregate Non-Founder Seller Amount, the Founder Seller Closing Cash Amount, the Founder Seller Closing Stock Amount, the Founder Seller Closing Cash Amount Per Share, the Founder Seller Closing Stock Amount Per Share, for each Founder Seller, the Individual Founder Seller Closing Cash Amount and the Individual Founder Seller Closing Stock Amount, for each Non-Founder Seller, the Individual Non-Founder Seller Closing Amount, the Non-Founder Seller Closing Amount and the Non-Founder Seller Closing Amount Per Share; (i) without derogating from Buyer’s rights under Section 1.10(a) or otherwise binding Buyer to a specific withholding amount or rate, the tax withholding rate and the total amount of Taxes (including for income, payroll, social security and other Taxes) to be deducted and withheld from the Aggregate Stock Consideration Amount that each Company Securityholder immediately prior to the Closing is entitled to receive pursuant to Sections 1.2(b) and (c); (j) the calculation of the Indemnity Holdback Amount, the Founder Seller Indemnity Holdback Amount, the Non-Founder Seller Indemnity Holdback Amount, the Indemnity Pro Rata Share of each Indemnifying Person; (k) the calculation of the Pro Rata Share; and (l) the calculation of the aggregate number of shares of Buyer Common Stock subject to the Founder Stock Restriction Agreement for each Seller Founder.

  • Notice of Completion; Copy of Record Set of Plans Within twenty (20) days after completion of construction of the Improvements, Tenant shall cause a Notice of Completion to be recorded in the office of the Recorder of the county in which the Building is located in accordance with Section 3093 of the Civil Code of the State of California or any successor statute, and shall furnish a copy thereof to Landlord upon such recordation. If Tenant fails to do so, Landlord may execute and file the same as Tenant’s agent for such purpose, at Tenant’s sole cost and expense. At the conclusion of construction, (i) Tenant shall cause the Architect and Contractor (A) to update the Approved Working Drawings as necessary to reflect all changes made to the Approved Working Drawings during the course of construction, (B) to certify to the best of their knowledge that the “record-set” of as-built drawings are true and correct, which certification shall survive the expiration or termination of this Lease, and (C) to deliver to Landlord two (2) sets of copies of such record set of drawings within one hundred twenty (120) days following issuance of a certificate of occupancy for the Premises, and (ii) Tenant shall deliver to Landlord a copy of all warranties, guaranties, and operating manuals and information relating to the improvements, equipment, and systems in the Premises.

  • State Specific Contract Form Observe the state of the Seller on the Contract, if the Seller lists an address in Alaska, Arkansas, Delaware, North Carolina, Virginia, Maryland, Montana, Connecticut, Vermont, Louisiana or Mississippi, confirm the form number on the Contract is on the List of Approved Contract Forms, for the corresponding state. Representation

  • Delivery Schedule The scheduled months of delivery of the Aircraft are listed in the attached Table 1. Exhibit B describes certain responsibilities for both Customer and Boeing in order to accomplish the delivery of the Aircraft.

  • Check and complete if Transferee will take delivery of a beneficial interest in the IAI Global Note or a Restricted Definitive Note pursuant to any provision of the Securities Act other than Rule 144A or Regulation S. The Transfer is being effected in compliance with the transfer restrictions applicable to beneficial interests in Restricted Global Notes and Restricted Definitive Notes and pursuant to and in accordance with the Securities Act and any applicable blue sky securities laws of any state of the United States, and accordingly the Transferor hereby further certifies that (check one):

  • Certificate of Analysis Seller shall provide a certificate of analysis and other documents as defined in the Quality Agreement for any Product to be released hereunder, in a form in accordance with the cGMPs and all other applicable Regulatory Requirements and Product Specifications and as shall be agreed upon by the parties. For any batch that initially failed to meet any Product Specification, the certificate of analysis shall document the exception. Products that do not meet dissolution specifications at USP Stage I and II testing shall not be accepted by Buyer (and such requirement shall be included in the Product Specifications/Quality Manual).

  • Contract Form Observe the Contract and confirm the form number on the Contract is on the List of Approved Contract Forms.

  • INSTRUCTIONS FOR COMPLETING REPAYMENT ELECTION FORM AND EXERCISING REPAYMENT OPTION Capitalized terms used and not defined herein have the meanings defined in the accompanying Repayment Election Form.

  • Notice of Completion Promptly after the completion of the distribution of the Securities by the Underwriters, the Representatives shall deliver to the Company a notice in writing confirming the completion of the distribution (the “Notice of Completion”).

  • Form of Rights Certificates (a) The Rights Certificates (and the forms of election to purchase and of assignment to be printed on the reverse thereof) shall each be substantially in the form set forth in Exhibit B hereto and may have such marks of identification or designation and such legends, summaries or endorsements printed thereon as the Company may deem appropriate and as are not inconsistent with the provisions of this Agreement, or as may be required to comply with any applicable law or with any rule or regulation made pursuant thereto or with any rule or regulation of any stock exchange on which the Rights may from time to time be listed, or to conform to usage. Subject to the provisions of Section 11 and Section 22 hereof, the Rights Certificates, whenever distributed, shall be dated as of the Record Date and on their face shall entitle the holders thereof to purchase such number of one one-hundredths of a share of Preferred Stock as shall be set forth therein at the price set forth therein (such exercise price per one one-hundredth of a share, the "Purchase Price"), but the amount and type of securities purchasable upon the exercise of each Right and the Purchase Price thereof shall be subject to adjustment as provided herein.

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