NOMINATED SIGNATORIES FORM

Only pharmaceutical companies who are members of the ABPI or on the “non-members” list of companies that have formally agreed to abide by the ABPI Code and accept the jurisdiction of the PMCPA are required to provide the PMCPA with details of their signatories using the form below.

Any pharmaceutical company that would like information about joining the “non-members” list, please contact the PMCPA here

It is the responsibility of the pharmaceutical company to ensure individuals nominated as signatories meet the qualification requirements stated in Clause 8 and its supplementary information.

Please note that your details will be treated according to our Privacy Policy.

ABPI member companies and those companies that are already signed up to the non-members list please submit details of nominated signatories below.

NOMINATED SIGNATORIES FORM

Name and job title of employee completing this form on behalf of the pharmaceutical company *

Pharmaceutical company *

Email (this must be a pharmaceutical company email address) *

Telephone number *

I hereby give an assurance that I have checked and verified that the following signatories fulfil the requirements in accordance with Clause 8 of the Code and its supplementary information *

PLEASE UPLOAD A DOCUMENT DETAILING ALL THE NAME(S), JOBTITLE(S) AND QUALIFICATIONS OF THE COMPANY'S NOMINATED SIGNATORY(S) AS SET OUT IN CLAUSES 8.1 AND 8.2. CLEARLY INDICATE WHICH ARE AQP SIGNATORIES AS SET OUT IN CLAUSE 8.2. *

Please confirm that you have consent of all the individuals listed on the form to provide their details to the PMCPA and that you have read our privacy policy *