Company Registration Form for the National AMU Surveillance System
English
Bangla
Portal login
Previous organization information has been auto-loaded. Last Visit Date:
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Company Details
Company Name
*
Company Type
*
Select Company Type
Human Medicine Manufacturer
Human Medicine Importer
Veterinary Medicine Importer
Veterinary Medicine Manufacturer
Company Description
Address
*
Email
*
Phone Number
*
Website
*
Latitude
*
Longitude
*
Country
*
Bangladesh
Select Country
Contact Person Details (Multiple)
Add Contact Person
Name
*
Department
*
Designation
*
Email
*
Phone Number 1
*
Phone Number 2
Person Responsible for AMU Data Submission (Multiple)
Add More Responsible Person
Name
*
Department
*
Designation
*
Email
*
Phone Number 1
Phone Number 2
Required Documents (Multiple)
Add More Manufacturing Site
Manufacturing Site
*
License Type
*
Select License Type
Manufacturing
Import
Import License Number
*
Valid Upto
*
Upload Logo (Max 1 MB)
Upload Logo Only (.png, .jpg, .jpeg)
Portal Access
User ID (Must be an Email address)
*
Must be at least 8 char, one uppercase letter, one number, and one special char.
*
Submit Registration
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