Form A
- Formulir Permohonan / Application form
- IPAK (Ijin Penyalur Alat Kesehatan) / Medical Device Distribution License
- LOA / Letter of Appointment : legalized
- CFS / Certificate of Free Sale : legalized
- ISO 13485
- Pernyataan merk dan surat pernyataan bersedia
melepas keagenan / Statement of Brand and Statement letter to willingly give in the distributor rights if there are other party more eligible.
Form B
- Uraian Alat / Description of device:
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Cara
Penggunaan / Direction of Use
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Indikasi / Indication
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Brosur / Brochure
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Material
Produk / Product Material
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Kadaluwarsa / Expiry date
- Deskripsi dan fitur Alkes / Description and Fiture of medical device
- Tujuan Penggunaan / Intended Use
- Indikasi / Indication
- Petunjuk Penggunaan / Direction for use
- Material / Composition
- Proses Produksi / Manufacturing procedure or Flow chart
Formulir C
- Karakteristik dan Spek Kinerja Teknis Alat / Characteristic and Specification of Finished Good
- Spek Bahan Baku / Specification of Raw Material
- Hasil Uji Analisis Alkes / COA of Finished product
Formulir D
- Contoh Penandaan / Leaflet
- Kode Produksi dan Arti / Production code and meaning
- Penandaan pada Alat / Labelling
- Manual Instruction (Inggris & Indonesia) *
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