Information on the quality of medicines -

The form contains the following set of fields:

«Full name of a legal entity, individual entrepreneur» - Field type text (obligatory)
«Surname, first name, patronymic (if any) or initials of the head or the person authorized in the prescribed manner to sign applications» - Field type text (obligatory)
«Postal code and address of location of a legal entity, individual entrepreneur» - Field type text (obligatory)
«Applicant's phone number for communication» - Field type text (obligatory)
«Applicant email address» - Field type E-mail (obligatory)
«Subject of the appeal» - Field type text
«Message text (up to 2500 characters)» - Field type several lines of text (obligatory)
«Attach file» - Field type file

The form has auto-fill protection

Full name of a legal entity, individual entrepreneur *

Surname, first name, patronymic (if any) or initials of the head or the person authorized in the prescribed manner to sign applications *

Postal code and address of location of a legal entity, individual entrepreneur *

Applicant's phone number for communication *

Applicant email address *

Subject of the appeal

Message text (up to 2500 characters) *

Attach file

Protection from automated form filling

Please type in the symbols shown in the image above*

Required Fields marked with *