Company Registration Form for the National AMU Surveillance System
English
Bangla
Portal login
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Company Details
Company Name
*
Company Type
*
Select Company Type
Human Medicine Manufacturer
Human Medicine Importer
Verteinary Medicine Importer
Company Description
*
Address
*
Email
*
Phone Number
*
Website
*
Latitude
*
Longitude
*
Country
*
Bangladesh
Select Country
Contact Person Details
Add Contact Person
Name
*
Department
*
Designation
*
Email
*
Phone Number 1
*
Phone Number 2
Person Responsible for AMU Data Submission
Name
*
Department
*
Designation
*
Email
*
Phone Number 1
Phone Number 2
Attachment of Required Documents
License Type
*
Select License Type
Manufacturing
Import
License Number
*
Date of Incorporation
*
Company Registration Number
*
Upload Logo
*
Upload Logo Only (.png, .jpg, .jpeg)
Trade License
*
Upload PDF or Image (.png, .jpg, .jpeg)
Import License
*
Upload PDF or Image (.png, .jpg, .jpeg)
Portal Access
Portal User Name (Must be an Email address)
*
Portal User Password (Min 8 Charecter)
*
Submit Registration
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