Price Certificate Form (Form 31) : Pack Size

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)‫ ﺑﻠد‬31 ‫ﻧﻣوذج ﺷﮭﺎدة اﻷﺳﻌﺎر )ﻧﻣوذج‬

Price Certificate Form (Form 31)


General

Pack
Product Name Concentration
Size
Pharmaceutical Company Name
information

Form & Nationality


Country of

Ex-Factory Price Wholesale Price Public Price Proposed CIF to GCC


(In Country of (In Country of (In Country of (In Country of Origin’s
Note
Origin’s currency) Origin’s currency) Origin’s currency) currency)
Origin

THE OTHER PRICE IN COUNTRIES WHERE THE PRODUCT IS MARKETED


currency

currency

currency
N Country Pack Ex-Factory CIF Public
o. Name Price Price Price
Notes
Size
1 Algeria
2 Australia
3 Argentina
4 Bahrain
5 Belgium
6 Canada
7 Cyprus
8 Denmark
9 Egypt
10 France
11 Germany
12 Greece
13 Holland
14 Hungary
15 Ireland
16 Italy
17 Japan
18 Jordan
19 Kuwait
20 New Zealand
21 Oman
currency
currency

currency
Country Ex-Factory CIF Public
No
Name
Packing
Price Price Price Notes

22 Portugal
23 Lebanon
24 Saudi Arabia
25 South Korea
26 Spain
27 Sweden
28 Switzerland
29 Turkey
30 U.A.E
31 U.K.

We: :‫تشهد شركة‬


Certify That all prices in this form are true. .‫أن جميع األسعار الواردة في هذا النموذج صحيحة‬
Name of the person authorized to sign on ‫ عن الشركة‬%‫اسم الشخص المفوض بالتوقيع‬
behalf of the company

Stamp ‫ختم الشركة‬

In case of registering multiple package sizes, ‫في حال وجود أكثر من عبوة مسوقة يُذكر سعر كل عبوة والبلدان المسوق‬
each pack must have a separate stamped form. .‫بها في نموذج مستقل مختوما بختم الشركة‬
.

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