Standard drug purchase and sale contract model 1
Party A:
Party B:
In order to build a new order of honest and fa
Standard drug purchase and sale contract model 1
Party A:
Party B:
In order to build a new order of honest and fair drug purchase and sale, maintain the results of centralized bidding and purchasing of drugs, improve the distribution rate of essential drugs and meet the needs of clinical drugs, according to the Contract Law, both parties signed the following contract through consultation:
I. Responsibility of Party A
(1) Party A guarantees that all drugs in the drug procurement catalogue agreed by both parties are purchased from Party B through the bidding procurement network of Henan Provincial Hospital, and may not be purchased from other companies without Party B's consent. ..
(2) According to the drug use situation, Party A's monthly purchase plan shall not exceed two times, and the same variety shall not exceed three product specifications. Party A shall fully consider the clinical first-aid needs and prepare sufficient first-aid drugs.
(3) Party A shall provide the places and personnel for the establishment of the drug turnover warehouse, and Party B shall share the expenses of infrastructure and necessary office supplies, each of which is 5,000 yuan (5,000 yuan). Party A shall guarantee to establish a drug turnover warehouse according to the requirements of the drug regulatory authorities after the funds are in place.
(4) Within the scope of quantity, specification, amount and time limit agreed in the contract, Party A shall not reject or return the qualified products delivered by Party B..
(5) Party A shall not settle the drug fee for more than 30 working days after receiving the drug invoice.
(VI) Party A has the right to evaluate the quantity, specifications, amount and timeliness of drugs distributed by Party B. ..
II. Responsibility of Party B
(1) Party B guarantees to provide Party A with qualified drugs that have won the bid according to the Catalogue of Centralized Bidding and Procurement of Drugs in Medical Institutions in Henan Province and the contents involved in this contract, and according to the drug procurement catalogue agreed by both parties.
(2) Party B shall provide Party A's drug turnover warehouse with the corresponding drugs in stock, so that Party A can obtain the required drugs in time under the principle of meeting the drug turnover. The ownership of the drugs in stock belongs to Party B, and during the performance of this contract, no payment request shall be made for the drugs in stock. Recover the drugs in stock when the contract is terminated.
(3) Party B has the ability to provide Party A with all drugs in the drug procurement catalogue agreed by both parties, and ensure timely and sufficient supply. For varieties that cannot be delivered due to market supply or pharmaceutical production enterprises, Party A shall be notified one month in advance to stop online procurement, and both parties shall negotiate to solve the problem. The two sides of the same variety with different origins or specifications exchange signed the Memorandum of Exchange of Essential Drugs Distribution between the Company and the Health Center (attachment 1), and agreed to terminate the drug distribution. The two sides signed the Memorandum of Termination of Essential Drugs Distribution between the Company and the Health Center (attachment 2), and the two sides signed the Memorandum of Termination of Essential Drugs Distribution between the Company and the Health Center for new drugs.
(4) The delivery time and quantity of Party B shall be subject to Party A's purchase plan or contract. First-aid drugs or first-aid drugs distribution time shall not exceed 4 hours, and the general drug distribution time shall not exceed 48 hours.
(V) Party B is fully responsible for the quality of the drugs that won the bid, and has the obligation to provide Party A with the required drug qualification documents. Party B shall bear all the responsibilities for drug quality problems.
(VI) Party B shall pay a performance bond of RMB 20,000.00 Yuan (RMB 20,000.00 Yuan) to Party A, and Party A shall return it to Party B (without interest) within 30 working days after the expiration of the contract.
Third, others.
(1) Party A and Party B * * jointly set up a coordination group for the distribution of essential drugs (see Annex 5 for the list of members), * * jointly supervise the performance of Party A and Party B's responsibilities, and coordinate the problems existing in drug distribution and payment.
(II) The drug turnover warehouse is jointly managed by Party A and Party B. Party A shall ensure that the safety, facilities and equipment of the drug warehouse meet the requirements of the drug regulatory authorities, and Party B shall ensure that the drug inventory meets the clinical needs of Party A, regularly check the expiration date of the drugs in stock and update them in time to prevent the occurrence of expired drugs. Drugs that are unsalable for more than two months shall be recycled by the distribution company.
(3) Party B shall share the operation and management expenses of 4,000 yuan (4,000 yuan) per month according to the proportion of drug distribution amount in the current month, and Party A shall be responsible for drug procurement in hospitals and village clinics.
(4) If Party B fails to notify Party A in advance and sign a memorandum agreement as agreed in the contract, and the drug distribution is not in place (including the quantity, quality and timeliness of distribution), each product will be fined one hundred yuan (65,438+000 yuan), and another 65,438+00% of the amount of timely drug distribution will be fined. The fine will be deducted from the deposit paid by Party B, and the contract relationship will be automatically dissolved after the deposit is deducted (see Annex 6).
(5) If the contract cannot be performed due to the adjustment of superior policies or other force majeure factors, the relevant policies shall prevail.
(VI) The validity of this contract is one year, from the date of 20th to the date of 20th.
Four. Default handling
(1) If both parties breach the contract, it shall be handled according to the relevant provisions of the Contract Law.
(2) Matters not covered in this contract shall be decided by both parties through consultation.
(3) This contract is made in duplicate, with each party holding one copy. Attached are six attachments.
Party A: (Seal) Party B: (Seal)
Representative of Party A: (signature) Representative of Party B: (signature)
Date of signing: Date of signing:
Model of standard drug purchase and sale contract II
Party A:
Party B:
In accordance with the Contract Law of People's Republic of China (PRC), Drug Administration Law of People's Republic of China (PRC) and relevant laws and regulations, Party A and Party B, on the principle of voluntariness, equality and mutual benefit, enter into this contract through consultation and abide by it jointly.
Article 1 Qualification certification materials
Before signing this contract, Party A and Party B shall exchange authentic and valid copies of the following documents and affix their official seals:
(Tick "√" in "□" when selecting, and "×" when selecting, the same below)
□ Drug wholesale enterprises: drug business license, business license, tax registration certificate, drug business quality management certification certificate and organization code certificate.
□ Retail pharmacies: drug business license, business license, tax registration certificate, and drug business quality management certification certificate.
□ For-profit medical institutions: practice license and business license of medical institutions □ Non-profit medical institutions: practice license of medical institutions.
Individual retail pharmacies and medical institutions (clinics) must also provide a copy of the identity card of the actual operator (boss).
If there is any change in the information provided by Party B, it shall go through the change formalities at the quality management department of Party A immediately. ..
Article 2 Determination of Subject Matter
During the performance of the contract, the specific name, specification, place of origin, quantity and price of the goods purchased by Party B shall be subject to the contents recorded in Party A's sales outbound order, unless Party B can prove the inconsistency.
Article 3 Quality Agreement
The quality of goods supplied by Party A shall meet the quality standards stipulated by the state.
Article 4 Mode of delivery
□ Delivered by Party A
□ Party B shall raise funds by itself.
□ Entrusted by Party A and carried by a third party. The freight shall be paid by Party A, to pay the freight.
To.
Article 5 Acceptance Methods
(1) When Party A delivers the goods, Party B shall timely check whether the received goods are in conformity with Party A's sales outbound order. If the goods are found to be in short supply, damaged, etc. , shall be calculated together with the delivery personnel of Party A.. If it is a delivery error of Party A, it shall be handled according to relevant procedures after verification by Party A, otherwise it shall be deemed as acceptable by Party B..
(2) Party B shall take the initiative to check with Party A's personnel on the spot whether the goods are in conformity with Party A's sales delivery note, and whether there are any errors, and raise them with Party A's personnel in time. After the self-picked goods leave Party A's warehouse, it shall be deemed that Party B has passed the acceptance.
(3) Third-party transportation
1. When receiving goods, Party B shall check whether the documents are clean and complete, and timely check whether the number of received pieces is consistent with the contents recorded in the waybill, and whether the outer packaging of the received goods is clean and damaged. In case of any abnormal situation, Party B shall refuse to receive the goods, ask the carrier for the documents signed by the carrier and the written materials explaining the abnormal situation, and immediately negotiate with the carrier for compensation.
2. Party B shall accept the goods immediately after receiving them. If it is found that the goods received are in short supply or damaged, it shall raise an objection within 3 days from the date of receipt of the goods and provide Party A with relevant certification materials (including all goods packaging cartons, photos, etc.). ), and cooperate with relevant personnel of Party A to understand. If it is put forward within the time limit, it shall be deemed that Party B has passed the inspection.
3. If Party B finds that the goods actually received are not in conformity with the sales delivery note within 3 days after receiving the goods, it shall follow the principle of good faith, notify Party A, and solve the problem by returning the goods or making up the difference.
(IV) After receiving the goods, Party B shall sign the sales delivery document of Party A attached to the goods and hand it over to Party A's business personnel. If Party B fails to sign or submit the signed document, it shall be deemed that the goods recorded in the sales delivery document have been received and Party A has fully fulfilled its obligations as agreed.
Article 6 Method of settlement
□ Advance payment
□ Payment before delivery
□ Cash on delivery
Party B pays the annual sales in advance, and Party A pays 5% to Party B at the end of the year.
The prepaid amount is RMB (in words).
Article 7 Payment Terms
□ Transfer cheque □ Entrusted collection
□ Exchange □ Three-month bank acceptance bill
Party B shall remit (deposit) the money to the account designated by Party A according to the provisions of Article 6 of this contract, and shall not deduct any fees.
In order to ensure that the accounts of both parties are clear, Party A and Party B shall sign reconciliation books regularly, and both parties shall cooperate with each other's representatives to sign them, and shall not pass the buck without reason.
Article 8 Return and exchange of goods
1. Party B shall apply for returning goods within 20 days from the invoice date of Party A's sales outbound order, and handle it through Party A's marketing personnel after Party A's consent. All expenses arising from the return shall be borne by Party B. Without Party A's consent or without Party A's marketing staff, Party B shall not return the goods by itself. Returns are not allowed to exceed 20 days. If the goods are returned without authorization, Party A refuses, and the consequences shall be borne by Party B..
2. Party A shall accept the return of goods according to the requirements of GSP, and shall not return goods in any of the following circumstances:
(1) Goods with damaged, polluted or other abnormal packages;
(2) Goods that are inconsistent with Party A's sales delivery list, fake and shoddy goods;
(3) Goods that Party B has opened or sealed, and goods with labels;
(4) When Party B puts forward the purchase plan, Party A has stated that the goods will not be returned;
(5) Promotional goods purchased by Party B during the promotion period of Party A;
(6) Return due to falling market prices;
(7) Valuable, refrigerated, special and specially adjusted goods and special goods.
3. It is confirmed that there are quality problems in the goods sold by Party A by the state administrative organs, inspection institutions, announcements and manufacturers' notices. If Party A notifies Party B to return the goods as required by GSP, Party B shall return the goods within the required time limit after receiving the return notice; if Party B fails to return the goods as required, Party B shall bear the administrative responsibility and the liability for damages to the third party.
4. If Party B thinks that the goods have quality problems and asks Party A to return them, Party A can handle them according to the opinions of relevant departments after consulting the opinions of state administrative organs, inspection institutions and manufacturers.
Article 9 Force Majeure
If the contract cannot be performed or can not be fully performed due to force majeure such as national emergency call and earthquake, the other party shall be notified within five working days after the end of the force majeure, and relevant supporting documents shall be issued.
After verification, the relevant responsibilities can be reduced or exempted. If force majeure occurs after delayed performance or improper performance, the relevant responsibilities cannot be alleviated.
Article 10 Liability for breach of contract
Party B shall pay the purchase price as agreed in the contract, and shall not terminate, partially perform or delay the performance of the contract at will, otherwise it shall compensate for the losses (including interest on the purchase price, dunning fee, lawyer's fee, notary fee, etc.). ) The losses caused to Party A therefrom, and pay liquidated damages.
Article 11 Calculation method of liquidated damages
Liquidated damages = payment receivable ×5‰× days of default (from overdue payment date to payment date)
Article 12 Term of validity of a contract
This contract shall come into effect after being signed or sealed by authorized representatives of both parties, and shall terminate on. After the expiration of this contract, if Party A and Party B continue to cooperate, this contract shall be renewed.
Article 13 Other agreed matters: (Other agreed matters, if filled in, shall be valid only after being signed or sealed by both parties or authorized representatives).
Article 14 Any amendment and supplement to this contract shall be recorded in written form. Party A has earnestly fulfilled the obligation of informing, read all the terms of this contract from Party B, and reminded Party B of relevant risks. Party B has carefully read this Agreement and its annexes, and clearly understood the rights and obligations of both parties, and both parties are willing to earnestly perform this Agreement.
Disputes arising from the performance of this contract shall be under the jurisdiction of the people's court where Party A is located. This contract is made in duplicate, one for each party, with the same legal effect.
Party A: Party B:
Address: Address:
Tel: Tel:
Chuan Zhen: Chuan Zhen:
Year, month, year, month, year
Model of standard drug purchase and sale contract 3
ContractNo.: _ _ _ _ _ _
Buyer: _ _ _ _ _ _ Seller: Sino-foreign Cooperative Pharmaceutical Co., Ltd.
The Buyer and the Seller confirm that the following commodities are sold according to the following terms and conditions:
Article 1 Name and specification of goods
Name _ _ _ _ Specification _ _ TrademarkNo. _ _ Quantity (unit) _ _ Unit price (yuan) _ _ Total price (yuan) _ _ Remarks _ _
Amount in words (total) RMB: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.
Article 2 Quality requirements and technical standards: The original factory standard shall be subject to the drug inspection report of the drug inspection office.
Article 3 Packaging standard: original packaging.
Article 4 Delivery Time: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Article 5 Delivery mode: The seller is responsible for delivering the goods to the other station.
Article 6 Mode of transportation and arrival (port); Railway or road transportation. Name of radio station: _ _ _ _ _ _ _
Article 7 Payment method: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ The date of payment is _ _ _ _ _ _ _ _ _ _, and the payment should be directly remitted to the seller's _ _ _ _ _ account, otherwise it will be regarded as unpaid.
Article 8 Delivery Notice
The seller shall provide the stock situation at any time so that the buyer can make preparations before receiving the goods. After each (batch) delivery, the seller shall notify the buyer of the delivery date, product name, number of pieces, weight of goods, arrival at the station, etc.
Article 9 If the buyer has any objection to the quality and quantity of the goods, he shall raise it with the seller within five days from the date of receiving the goods, otherwise it shall be deemed that the quality and quantity of the goods meet the requirements of the contract.
Article 10 Liability for breach of contract: If the buyer fails to pay the purchase price, it shall pay the seller a penalty of 5% of the total contract price.
Article 1 1 Force Majeure
Force majeure under this contract refers to events that both parties cannot foresee when signing the contract, and their occurrence and consequences cannot be avoided or overcome, including earthquakes, fires, regional floods, storms and changes in national laws and regulations. Because one side cannot.
If the Contract cannot be performed due to force majeure, the valid force majeure certificate issued by the notary office or government department shall be provided to the other party within 15 days after the force majeure event, and the performance of the Contract may be postponed, partially performed or not performed.
Article 12 Settlement of disputes
All disputes arising from this contract between the Buyer and the Seller shall be settled through friendly negotiation first. If negotiation fails, either party shall bring a lawsuit to the court or relevant arbitration institution where the seller is located, and the court (or arbitration institution) where the seller is located shall make a ruling.
Article 13 the validity of the contract
This contract shall come into effect as of the date of signature and seal by authorized representatives of both parties. This contract shall not be modified unilaterally. If either party changes, modifies or terminates this contract for any reason, it must be agreed by both parties through consultation, and a separate agreement shall be signed for the record.
Article 14 This contract is made in triplicate, one for each party and one for the seller's record.
Article 15 The main clauses in Article 1- 15 of this contract shall not be changed, and the change shall be invalid.
Buyer: _ _ _ _ _ _ _ Seller: _ _ _ _ _ _ _ _
Signature: _ _ _ _ _ _ _ Signature: _ _ _ _ _ _ _
Date: _ _ _ _ _ _ Date: _ _ _ _ _ _ _ _
Model of standard drug purchase and sale contract 4
The date of this contract is _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Whereas, the medical institutions conduct centralized bidding for the following drugs and accompanying services, and the bidder's bid for the above drugs has been accepted (see the bidding quotation sheet for details). This contract states as follows:
1. The meanings of words and terms in this contract are the same as those in the general terms and conditions of the contract.
2. The following documents are part of this contract and should be read and interpreted together with this contract:
(1) the letter of tender and tender offer submitted by the bidder;
(2) List of drug demand;
(3) the general terms and conditions of the contract and the former schedule;
(4) Letter of acceptance.
3. The bidder hereby guarantees that it will provide medicines and accompanying services to medical institutions in accordance with the provisions of the contract and repair defects.
4. See the attached table for the drugs involved in the contract.
This contract is valid for one year. During the contract period, in case of national regulations or new document resolutions, the national regulations and new document resolutions shall prevail.
6. This contract is made in quadruplicate, with Party A and Party B holding one copy respectively, and the Municipal Supervision and Administration Committee for Centralized Bidding for Medicines and Medical Devices (Consumables) and the Municipal Management Committee for Centralized Bidding for Medicines of Medical Institutions holding one copy respectively.
Party A (seal) _ _ _ _ _ _ _ _ _ _ _ _
Representative of Party A (signature) _ _ _ _ _ _ _ _ _ _ _
Date of Signing: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Party B (Seal) _ _ _ _ _ _ _ _ _ _ _ _
Representative of Party B (signature) _ _ _ _ _ _ _ _ _ _ _ _
Date of Signing: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Model of standard drug purchase and sale contract 5
Party A: _ _ _ _ _ _ _ _ (medical institution)
Party B: _ _ _ _ _ _ (dealer)
According to the provisions of the Drug Administration Law of People's Republic of China (PRC), the Implementation Plan for Sunshine Procurement of Drugs is within _ _ _ _ _ _ _ _ years.
Article 1 According to the drug information provided by Party B in Guangdong Pharmaceutical Purchasing Service Platform (hereinafter referred to as the "Platform"), Party A purchases the following drugs by online purchasing (see Annex 1), and Party A sends an order notice to Party B through the online drug trading system, and Party B supplies accordingly; The order confirmed by both parties is an important part of this contract.
Party B must confirm the order notice sent by Party A through the platform within one working day after Party A sends the order notice.
Article 2 Party B shall supply drugs to Party A according to the drug purchase list (see attached table) in the purchase and sale contract.
Article 3 Party B shall ensure that Party A will not be required by a third party to claim patent right, trademark right or protection period when using drugs.
Article 4 The quality of drugs supplied by Party B shall conform to the national drug-related standards, and the packaging, quality and price of drugs shall be consistent with the attached online information of varieties, which shall not be changed. Party B shall provide the corresponding drug inspection report as required by Party A, and deliver the drugs to the place designated by Party A. ..
Article 5 Terms of Supply
Party B shall deliver the goods within one working day after confirming Party A's order notice, and the longest time shall not exceed two working days; First-aid drugs shall be delivered by Party B within 4 hours.
Article 6 Supply price settlement and payment for goods.
(1) Supply price: it shall be implemented according to the purchase price published by the platform, and the purchase price includes all additional expenses such as capital, transportation, packaging, accompanying services and taxes; During the performance of the contract, in case of policy price adjustment, the price shall be updated according to the platform, including unsold drugs.
(II) Payment settlement: Party A shall make payment settlement no later than 60 days from the date of receiving the distributed drugs.
Article 7 Acceptance and Objection of Drugs
Party A has the right to reject drugs whose quality, expiration date, packaging and order number do not meet the requirements, and Party B shall replace the drugs that do not meet the requirements in time, which shall not affect the clinical application of Party A. If Party A fails to use, keep or maintain the products for its own reasons, the consequences shall be borne by Party A..
Article 8 Party A's liability for breach of contract
(1) In violation of the provisions of this contract, Party A purchases and replaces drugs entering the enclosure through the platform, and assumes the liability for breach of contract;
(2) If Party A refuses to receive the goods or defaults in payment without justifiable reasons, it shall bear the losses caused by Party B;
In the above two cases, Party B has the right to report to the office of the local leading group for correcting unhealthy practices in the purchase and sale of medicines and medical services.
Article 9 Party B's liability for breach of contract
(1) If Party B refuses to supply all the goods after confirming the order notice sent by Party A, it shall be liable for breach of contract.
(2) If the quality of drugs supplied by Party B does not meet relevant regulations, it shall be handled according to relevant laws and regulations.
In the above two cases, Party A has the right to report to the local leading group office for correcting unhealthy practices in the purchase and sale of medicines and medical services.
Article 10 If the contract is delayed or terminated due to force majeure, both parties to the contract shall not be liable for compensation. ("Force Majeure" refers to unforeseen events beyond the control of both parties to the contract, but does not include the breach or negligence of one party to the contract. These events include but are not limited to: war, serious fire, flood, typhoon, earthquake and other events agreed by both parties). After the occurrence of force majeure, both parties to the contract shall notify the other party of the force majeure in writing as soon as possible. Unless otherwise required, both parties to the contract shall continue to perform their contractual obligations as far as possible and seek to adopt a fair scheme to perform other matters that are not affected by force majeure. After the influence of the force majeure event is eliminated, both parties can reach an agreement to sign a bank contract within a reasonable time through consultation.
Article 11 Modification and rescission of the contract
If the Contract cannot be fulfilled due to the closure, suspension of business, merger or transfer of the pharmaceutical production enterprise, Party B shall promptly notify Party A and provide confirmation from the pharmaceutical regulatory authorities at or above the provincial level, and both parties may terminate the contract for the drug. If it is necessary to change the contract, it must be settled by both parties through consultation.
Article 12 For matters not covered in this contract, According to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ If it is still uncertain, a supplementary agreement can be signed by both parties through consultation according to the above two documents and relevant laws and regulations, and the supplementary agreement has the same legal effect as the formal contract.
Article 13 Any dispute arising from or related to this contract shall be settled by both parties through consultation. If negotiation or mediation fails, both parties may submit the dispute to arbitration or bring a lawsuit to the people's court in accordance with relevant laws and regulations.
Article 14 This contract shall come into force as of the date of signing by both parties, and all matters related to online transactions during the contract period shall be bound by this contract.
Article 16 The term of validity of this contract is from _ _ _ _ _ _ _ _ _ _ _ _.
This contract is made in duplicate, one for each party.
Party A (agent): _ _ _ _ _ _ Party B (seal): _ _ _ _ _ _ _
Authorized representative (signature): _ _ _ _ _ _ Authorized representative (signature): _ _ _ _ _ _ _
Date of signing: _ _ _ _ _ _ _ Date of signing: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
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