FORM 40
(See rule 24-A)
Application for issue of Registration Certificate for import of drugs into India
under the Drugs and Cosmetics Rules 1945
I/We*___________________________ (Name, full address with telephone, fax
and E-mail address) hereby apply for the grant of Registration Certificate for the
manufacturer, M/s. ___________________ (full address with telephone, fax and
E-mail address of the foreign manufacturer) for his premises
M/s________________(full address with telephone, fax and E-mail address),
and manufactured drugs meant for import into India.
1. Names of drugs for registration.
S. Name of Medical Devices Indication and/or Intended Use
No. (Including model No’s, if
applicable)
2. I/We enclose herewith the information and undertakings specified in Schedule
D (I) and Schedule D(II) duly signed by the manufacturer for grant of Registration
Certificate for the premises stated below.
3. A fee of_______________for registration of premises, the particulars of which
are given below, of the manufacturer has been credited to the Government under
the Head of Account "0210-Medical and Public Health, 04-Public Health, 104-
Fees and Fines” under the Drugs and Cosmetics Rules, 1945-Central vide
Challan No.________ dated__________________(attached in original).
4. A fee of__________________for registration of the drugs for import as
specified at Serial No. 2 above has been credited to the Government under the
Head of Account "0210-Medical and Public Health, 04-Public Health, 104-Fees
and Fines" under the Drugs and Cosmetics Rules, 1945-Central vide Challan
No._______, dated___________. (Attached in original).
5. Particulars of premises to be registered where manufacture is carried on:
Address _____________
Telephone No. _____________
Fax No. _____________
E-mail _____________
I/We* undertake to comply with all terms and conditions required to obtain
Registration Certificate and to keep it valid during its validity period.
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Place: __________
Date: ___________
Signature of the Indian Agent
(Name & Designation)
Seal / Stamp
(Note: In case the applicant is an authorized agent of the manufacturer in India,
the Power of Attorney is to be enclosed).
*Delete whichever is not applicable.
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