For distributors Form

1. Company name

2. Registration code

3. VAT identification number

4. Company registration date

5. Link to the company register of your country

6. Address

7. Phone number

8. Email address

9. Web site address

10. Social media addresses

11. CEO, controlling shareholders

12. Number of employees (of which work full-time)

13. Contact persons, their positions, contact details

14. Available ISO standard certificates (attach)

15. Brief introduction of the company's activities:
a. Own production of medical devices: experience, information about these devices, certification – registration data

b. Distribution of other manufacturers' medical devices: experience, which manufacturers are represented, with which products

c. Provided services: nature and experience

16. Declaration of possible conflicts of interest related to the distribution of Baltic Implants products

17. Presentation of activities goals in distributing Baltic Implants products

18. Legal regulation of medical devices in your country:
a. Do EU manufacturers have to register their manufactured medical devices in your country (and specifically personalised medical devices) to distribute them? If it depends on the class of medical devices, please detail it. References to relevant legislation.

b. What legislation regulates language requirements for medical devices documentation distributed in your country, both for registering these products (if applicable) and for placing them on the market? References to relevant legislation.

c. Does the national health insurance fund compensate the acquisition of personalised implants and surgical guides? If it depends on specific medical devices, please detail. References to relevant administrative legislation.