Local Company Registration

Local Company Email *

Confirm Local Company Email

Company Details

Local Company Name *

Company Type

Local Manufacturer

Local Marketer

Both

Company Category

Pharmaceutical

Representative Office

Cosmetic

Ministry of Health or Manufacturer License Number *

Ministry of Health or Manufacturer License Expiry Date *

Ministry of Health or Manufacture License *
( Attach Company Registration Copy )

Company Contact Details

Phone Number *

Desk Phone Number (Optional)

Local Company Address*

Official Representative / Contact Person Details

Contact Person Name *

Phone Number *

Alternate Phone Number (Optional)

Govt. Approved ID Proof *
(Upload National ID card or Foreign Passport)

Authorization Letter (Scanned copy) *

Contact Person Address *

Contact Person Detail

I am the owner

I am an employee

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