Transfer of MA templates - Attachment 1



Letter head Transferor

Attachment 1

The name of the medicinal product concerned, the authorisation number(s) and the date on which the authorisation was granted

{Date}

{EMEA/H/C/xxx}

Dear Sir or Madam

Re: {Product Name (active substance)}

Application for Transfer of Marketing Authorisation from {name Transferor} to {name Transferee}

The marketing authorization to be amended by this Transfer procedure relates to the following medicinal product:

|{Name of the Medicinal Product}: | |

|{Active Substance}: | |

|{Marketing Authorisation Number(s)}: |{EU/…} |

|{Date of Marketing Authorisation* }: | |

* Mentioned in the section “Authorisation details” of the product-specific webpage on the EMA website

Yours faithfully

{Title, name, position} {Title, name, position}

For and on behalf of {name Transferor} For and on behalf of {name Transferee}

(The 'Transferor') (The 'Transferee')

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