BCDEFGHIJKLMNOPQRSTUVWXYZ
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Distributor Information form
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Company Name:
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Contact Person & Designation
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Telephone
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Mobile
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Email
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Address
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city
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state
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Zip code
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Country
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Year of Establish ment
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Medical licence number
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Branches
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StaffSales AdministrativeOthers
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Sourcing of products ( √ ⁄ ‒ )LocalImportedOthers
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Products Dealing ( √ ∕ − )OpthalmologyNon ophthalmologyothers
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 Products Distributed- OphthalmologyBrands
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Annual TurnoverOpthalmologyNon OphthalmologyTotal
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2016
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2017
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2018
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Market Data
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Number of Public Hospitals
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Number of eye Hospitals
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Number of Pvt Doctors
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No of Ophtalmic Doctors in Contact
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Number of eye Hospitals in contact
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Cataract surgeries performed / year
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Market Data - Ophthalmic Knives
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BrandMarket SharePriceRemarks
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Participation in Ophtahlmic conferences of Country YearName of ConferenceYes/No
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Regulatory
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As Opthalmic knives come under -Class -2B,is the product Registration required ? If Yes What is the Duration Required?
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Signature: Grace
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Name and Title:
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Date :
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Please Attach your company Profile with website details & email to us
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