STATEMENT OF LICENSING STATUS OF PHARMACEUTICAL PRODUCT(S)

No. of statement:

Exporting (certifying) country: Slovenia

Importing (requesting) country:

This statement indicates only whether the following products are licensed to be put on the market in the exporting country.

Applicant (name/address):

Name of product	Dosage form	Active ingredient(s) and amount(s) per unit dose:	Number of product licence and date of issue

The certifying authority undertakes to provide, at the request of the applicant (or, if different, the product-licence holder), a separate and complete Certificate of a Pharmaceutical Product in the format recommended by WHO, for each of the products listed above.

Address of certifying authority:	Agency for medicinal products and medical devices of the Republic of Slovenia, Slovenčeva ulica 22, 1000 Ljubljana, Slovenia

Telephone/fax numbers:	+386 (0)8 2000 500 /+386 (0)8 2000 510

Name of authorized person:	Momir Radulović, MPharm
Direktor

Signature:

Stamp and date:

This statement conforms to the format recommended by the World Health Organization.