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NOTIFICATION OF CANCELLING A MARKETING AUTHORISATION The marketing authorisation or registration holder or a person or company authorised by the holder should submit a written notification before the end of the authorisation year if the authorisation is to be cancelled and the annual fee left unpaid. (Finnish Medicines Agency Fimea administrative regulation 2/2013, Applying for and maintaining a marketing authorisation and registration for a medicinal product / section 7.2.1 Cancelling a marketing authorisation or registration.) THE MARKETING AUTHORISATION IS TO BE CANCELLED STARTING FROM THE FOLLOWING DATE Year Month Day Type of medicinal product/preparation Human medicine Veterinary medicine Herbal medicinal product Parallel imported product PRODUCT DETAILS Marketing authorisation number Name of the medicinal product Strength Pharmaceutical form Marketing authorisation holder CONTACT DETAILS FOR THE SENDER Company name Surname First name Address Phone Fax E-mail address Fimea 5.2014 Other comments DATE AND SIGNATURE Date Signature NB. A single form can be used for the cancellation of several marketing authorisations, provided that all the marketing authorisations listed in the form have the same cancellation date. The marketing authorisation cancellation form is available at the Finnish Medicines Agency Fimea website at the following address: http://www.fimea.fi/lomakkeet The signed marketing authorisation cancellation form should be submitted without delay to the following address: Finnish Medicines Agency PO Box 55 FI-00034 FIMEA, FINLAND Fax +358 29 522 3014 Lääkealan turvallisuus- ja kehittämiskeskus | Säkerhets- och utvecklingscentret för läkemedelsområdet | Finnish Medicines Agency P.O.Box 55, FI-00034 FIMEA, FINLAND | Tel. +358 29 522 3341 | [email protected] | www.fimea.fi | Business ID: 0921536-6