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Organization Information:

Organization Name *

Organization Type (hospital, clinic, medical center, etc.)

Emirate of Registration *

Medical Activity License*

License Number *

Issue Date *

Expiry Date *

Registered Address *

Company Website

Founder/Owner Information:

First Name *

Last Name *

Nationality *

TIN/Passport Number *

Contact Phone *

Email *

Password *

Confirm Password *

Contact Information of Purchasing Manager:

Full Name *

Contact Phone *

Position *

Email *

Medical Activity Information:

Specializations and Departments (list of services) *

Number of Doctors/Medical Staff *

Number of Hospital Beds (for inpatient facilities) *

Attach Documents:

Scanned Copy of Medical Activity License *

Drop your file here or click here to upload You can upload up to 1 files

Scanned Copy of Organization Registration Document *

Drop your file here or click here to upload You can upload up to 1 files

Scanned Copy of Founder/Owner Identification Document *

Drop your file here or click here to upload You can upload up to 1 files

Certificates/Permits for Medical Equipment Usage (if applicable)

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Documents Confirming Medical Staff Qualifications (if applicable)

Drop your file here or click here to upload You can upload up to 100 files

Consent to Personal Data Processing *

Confirmation of Information Accuracy *

Company Information:

Company Name *

Trade Name (if different)

Emirate of Registration *

Commercial Activity License (Trade License)*

License Number *

Issue Date *

Expiry Date *

Registered Address *

Company Website

Founder/Owner Information:

First Name *

Last Name *

Nationality *

TIN/Passport Number *

Contact Phone *

Email *

Password *

Confirm Password *

Medical Products Trading Information:

Types of Medical Products for Sale *

Medical Products Import License*

License Number *

Issue Date *

Expiry Date *

Issuing Authority*

Countries of Origin for Imported Products *

Confirmation of Free Sale Certificates/Registration Certificates *

Confirmation of Product Conformity Assessment Documents for UAE Requirements *

Attach Documents:

Other Relevant Business Registration Documents

Drop your file here or click here to upload You can upload up to 1 files

Scanned Copy of Trade License *

Drop your file here or click here to upload You can upload up to 1 files

Scanned Copy of Medical Products Import License *

Drop your file here or click here to upload You can upload up to 1 files

Scanned Copy of Founder/Owner Identification Document *

Drop your file here or click here to upload You can upload up to 1 files

Scanned Copy of Power of Attorney/Contract from Manufacturer/Supplier for Product Distribution Rights *

Drop your file here or click here to upload You can upload up to 1 files

Other Relevant Business Registration Documents

Drop your file here or click here to upload You can upload up to 1 files

Consent to Personal Data Processing *

Confirmation of Information Accuracy *

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Organization Information:

Medical Activity License*

Founder/Owner Information:

Contact Information of Purchasing Manager:

Medical Activity Information:

Attach Documents:

Company Information:

Commercial Activity License (Trade License)*

Founder/Owner Information:

Medical Products Trading Information:

Medical Products Import License*

Issuing Authority*

Attach Documents:

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