You can open the FDA Letter of Authorization Template in multiple formats, including PDF, Word, and Google Docs.
FDA Letter Of Authorization Template Printable | Editable FormSample
Examples
[Your Name]
[Your Title]
[Your Organization]
[Your Address]
[Your Phone]
[Your Email]
[Recipient’s Name]
[Recipient’s Title]
[Recipient’s Organization]
[Recipient’s Address]
[Date of Issuance]
Letter of Authorization for FDA Submissions
This Letter of Authorization is provided to authorize [Recipient’s Name] at [Recipient’s Organization] to act on behalf of [Your Organization] in all matters pertaining to submissions to the U.S. Food and Drug Administration (FDA).
The undersigned hereby grants the authority to [Recipient’s Name] to submit, amend, and withdraw documents, receive communications from the FDA, and act in all matters as if they were the designated representative of [Your Organization].
This authorization is effective as of [Start Date] and will remain in effect until [End Date] or until revoked by written notice.
The authorized representative agrees to adhere to all applicable FDA regulations and requirements and to keep [Your Organization] informed of all relevant communications and documentation.
This authorization can be revoked at any time by providing written notice to [Recipient’s Name] and the FDA.
This agreement will be governed by the laws of [State/Country].
[Signature of the Authorizer]
[Name of the Authorizer]
[Title of the Authorizer]
[Your Name]
[Your Position]
[Your Company]
[Your Company Address]
[Your Company Phone]
[Your Company Email]
[Recipient’s Name]
[Recipient’s Title]
[Recipient’s Company]
[Recipient’s Company Address]
[Date of Issuance]
Authorization for FDA Interactions
This document serves as an official Authorization allowing [Recipient’s Name] to represent [Your Company] in all matters pertaining to FDA submissions.
The undersigned gives [Recipient’s Name] the authority to act on behalf of [Your Company] in connection with all communications and submissions to the FDA.
This authorization shall commence on [Start Date] and shall continue until [End Date] unless revoked by written notice.
The authorized individual agrees to comply with FDA regulations, maintain accurate records, and communicate with [Your Company] regarding any FDA-related correspondence.
The authority granted herein may be revoked at any time through written notice to both [Recipient’s Name] and the FDA.
This Letter of Authorization shall be governed by the laws of [State/Country].
[Signature of the Authorizing Party]
[Name of the Authorizing Party]
[Position of the Authorizing Party]
Format
Please complete the form below to create the FDA Letter of Authorization Template. All fields must be filled out to ensure a clear and complete authorization letter. We provide examples to guide you through each step. FDA Letter of Authorization Template 1. Applicant Information 2. Authorized Representative Information 3. Purpose of Authorization 4. Description of Products 5. Scope of Authorization 6. Duration of Authorization 7. Confidentiality and Compliance 8. Acknowledgment of Terms 9. Signatures and Acceptance
PDF
WORD
Google Docs
FDA Letter Of Authorization Template Printable | Editable FormPrintable
