Letter of Authorization: ............... (List of The Medical Device) ...........

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Logo, Name and address of the owner of the medical equipment

..................[Date]..............

LETTER OF AUTHORIZATION
To: Ministry of Health (Department of Medical Equipment and Construction

We, (name and address of the Product Owner), as the owner of the medical devices listed hereunder,
hereby authorize Orient Pharma Co., Ltd (ORIPHARM) located at 119 Road No.41, Tan Quy
ward, District 7, HCMC, Vietnam to place/register the following medical devices to the market of
Vietnam:

...............(List of the medical device)............

We hereby commit to provide and support any inquiry related to the information and quality of the
medical devices, guarantee all warranty, maintenance and service conditions and supply replacement
materials and accessories for the medical devices

This LETTER OF AUTHORIZATION is valid until: 31/12/2021

 Legal representative of the owner

Signature: [ full name, tittle] ……………………………………


[Verified with seal or digital signature]

Date: …………………………………………

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