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Customer Details

Customer Name:*

New / Existing Customer:* New Existing

Contact Person:*

Contact Email:*

Contact Phone:*

Date:

Product Details

Suggested product name:

Price range per unit:

Dosage form (e.g. film coated tablet/soft capsule/hard capsule):

Preferred tablet coating colour (e.g. clear/green/red/white/other):

Amount required (150K/300K/500K/other):

Packaging bottle (glass/plastic):

Packaging cap (standard cap, colour):

Packaging size (e.g. 60 film coated tablets):

Any other packaging requirements:

Label (customer supplied/through CMG):

Carton (e.g. box) (Y/N), and type:

Projected Delivery Date (*see end of document for information on lead time)

TGA Listing and Evidence Package

Evidence Package and indications required (if yes, quote will be provided shortly): Yes No

ARTG listing completed by CMG (note customer pays listing cost): Yes No

ARTG listing by customer: Yes No

Stability Testing

0, 3 months, 6 months, 9 months, 12 months, 18 months, 24 months, 36 months – cost to be determined

(Initial time point 0 + minimum of 4 time points)

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