TGA use only
This form, when completed, will be classified as 'For official use only'.
For guidance on how your information will be treated by the TGA see: Treatment of information provided to the TGA at
<https://www.tga.gov.au/treatment-information-provided-tga>.
Six monthly report
Export of unregistered therapeutic good(s)
Six monthly report by the applicant, approved under Subsection 19(1)(b) of the Therapeutic Goods
Act 1989.
Protocol No.:
Company name:
Original approval letter Ref. No.:
(example: EX15/XXXXXX)
Report for the six month period ending:
30 June
(year: yyyy)
31 December
PO Box 100 Woden ACT 2606 ABN 40 939 406 804
Phone: 1800 020 653 Fax: 02 6203 1605 Email: [email protected] https://www.tga.gov.au
Reference/Publication #
(year: yyyy)
Details of specified goods exported
Clinical trial
good(s) and
presentation
(e.g. kit)
Recipients name
(e.g. PI)
Site name/
Distribution centre
Address
(including country)
Signed on behalf of
exporter:
Total No.
of units
exported
Date:
* NB: Please email the completed six monthly report forms to: [email protected]*
Six monthly report - Export of unregistered therapeutic good(s) (August 2015)
For official use only
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