CONTROL FEE REPORT FORM 2011
FOR HOLDERS OF MARKETING AUTHORISATIONS
MEDICINAL PRODUCTS - SALES IN NORWAY
Please send form by e-mail to:
Refer to guidelines on www.legemiddelverket.no Audited form if sent by mail:
NOMA will send invoice based on reported figures. Sven Oftedalsv. 8
TELEFAX: 00 47 22 89 77 99
Name of company
City E-mail address:
Country Contact person:
(Figures in NOK)
Control fee % 2011: 0.6
Liable turnover of Liable turnover of Control fee Control fee
Please fill in coloured cells. medicinal products medicinal products
i tabellen Total this period Accumulated this year Total this period Accumulated this year
January - March. 1. Quarter
April - June. 2.Quarter
July - September. 3. Quarter
October - December. 4. Quarter
We ask for quarterly reports, even if liable turnover is zero.
We confirm that proceedings are in accordance with the guidelines.
Companys signature: Date:
Attestation from accountant must be included in the report stating the accumulated control fee no later than two months after termination of accounting year.
Signing accountant confirms that the total fee of: NOK
regarding 2011 has been paid in accordance with the control fee guidelines.
We confirm that the company has established a reporting system generating the necessary information to calculate the control fee.
We confirm that the system was controlled and tested: Date of most recent control:
Accountant signature Date:
Telephone: E-mail address: