Notification form: Lapses in medical device conformity assessment certification

I am the person in relation to whom the medical devices are included in the ARTG for the purposes of this notification.

OR

I am authorised to act on behalf of the person in relation to whom the medical devices are included in the ARTG for the purposes of this notification (for instance, the agent).

The information provided in this form is to the best of my knowledge, complete, current and correct.

Providing information that is false or misleading to a Commonwealth entity or in connection with a Commonwealth law is a serious offence subject to criminal penalties under the Criminal Code Act 1995.