Annual Charge Waiver or Refund for ARTG Entries Subject to Reclassification - About the Submitter - Therapeutic Goods Administration

About the Submitter

This page has questions about you, the person submitting this form.

1. What is your name?

(Required)

2. What is your email address?

Email (Required)

Please confirm your email address (Required)

3. What is the name of your organisation?

(Required)

4. Which of the following best describes your role in relation to the medical device(s) for which this form is being submitted?

Agent (please respond to the question below) Sponsor Manufacturer (please respond to the question below) Both sponsor and manufacturer

If you are an agent or a manufacturer, please provide the sponsor's name for device(s) included in this form:

5. Which financial year are you applying for an annual charge waiver or refund?

Financial Year (Required)