This dealer application form is used by businesses to apply for a license to distribute pharmaceutical or regulated products. It is administered by the Medicines and Healthcare products Regulatory Agency (MHRA) and covers new license applications and third-party site requests. Applicants must supply a checklist with payment confirmation and completed sections covering administrative data, site details, and responsible persons.
The form collects key business information, including the company legal name, trading styles, registered address, and contact number. Applicants must state the type of license requested, whether for a licensed dealer arrangement or a General Sales List category. The form also asks whether the business operates as a registered pharmacy and requires information about annual turnover, number of employees, and business partners.
Each site listed in the application must include details on the types of products handled, on-site activities, and whether any special manufactured products or unlicensed medicinal products are involved. Providing accurate date records and supporting documentation is necessary to meet regulatory requirements and safeguard public health. Any change to business activities must also be reported to ensure continued compliance with applicable trade regulations.
| Question | Answer |
|---|---|
| Form Name | Dealership Application Form |
| Form Length | 17 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 4 min 15 sec |
| Other names | dealer application form pdf, dealer registration form, dealer form format, dealership form |