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WHO COLLABORATING CENTRE FOR<br />

DRUG STATISTICS METHODOLOGY<br />

Postal address: P.O.Box 4404 Nydalen, 0403 Oslo, Norway<br />

Courier address: Marcus Thranes gate 6, 0473 Oslo, Norway<br />

Telephone: +47 21078160, Telefax: +47 21078146, E-mail: whocc@fhi.no<br />

Application form for new ATCvet codes<br />

(A separate form should be filled in for each dosage form)<br />

Requested by:<br />

Name:<br />

Company:<br />

Address:<br />

Country:<br />

Email:<br />

Active ingredients (preferably INN names):<br />

Brand name:<br />

Dosage form:<br />

Strengths:<br />

Manufacturer:<br />

Main indication*:<br />

Other indications*:<br />

ATCvet code proposal:<br />

* References should be given (e.g. from Summary of Product Characteristics approved in………..)

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