Taotlus riigilõivu tagastamiseks

State Agency of Medicines 1 Nooruse Street EE-50411 Tartu Estonia Phone: +372737 4140 E-mail: [email protected] Subject: Refund for Submission of Variation Application Dossier(s) for Vermox 100 mg tablet (MA number: 093694) Dear Sirs, Gedeon Richter Romania S.A., as applicant, would like to request for submitted variation application for Vermox 100 mg tablet (MA number: 093694), type IA B.III.1.a.2, partially refund of the state fee paid for this application. Applicant name: Gedeon Richter România S.A. The person for contacts (name, phone, e-mail): Lidia Dracea, Head of Regulatory Affairs Department Gedeon Richter România S.A. Cuza Vodă street, 99-105 540306 Târgu-Mureş, Romania Phone number: +40 265 201266 Fax number: +40 265 251093 E-mail: [email protected] Bank details and the account from which the state fee has been paid: Gedeon Richter România S.A. Cuza Vodă street, 99-105 540306 Târgu-Mureş, România VAT number: RO1200929 Bank details: account IBAN: RO36RNCB0188034961780018 SWIFT: RNCBROBU Banca Comerciala Romana S.A. Tg.Mures Romania Date of the payment: 09.10.2024 Bank details and the account where the state fee has been paid to: Beneficiary‘s address Ministry of Finance (Rahandusministeerium) Suur-Ameerika 1, Tallinn 10122, ESTONIA Beneficiary's Bank Swedbank Beneficiary‘s Bank address Liivalaia 8, 15040 Tallinn, ESTONIA IBAN-CODE EE932200221023778606 Swift code HABAEE2X Page 1/2 99-105 CUZA VODĂ ST. • 540306 TÂRGU-MUREŞ • ROMANIA V.A.T. NO.: RO1200929 • REG. NO. T.R.O.: J26/15/91 TEL.: +40 - 265 - 264.067 • FAX: +40 - 265 - 268.875 • E-MAIL: [email protected] Name of the performance of which the request the refund of the state fee is applied, the amount of the requested state fee and the legal ground for refund; for Medicinal product Vermox 100 mg tablet (MA number: 093694) for Variation Application Dossier Type IA B.III.1.a.2, the amount of 169 Euro was paid instead of 16 Euro. For this variation application we kindly request a refund of amount of 153 Euro. Bank details and the account where state fee should be refunded (bank, account no, name of the owner of the account, personal identification code or registration code, also SWIFT and IBAN if applicable): Gedeon Richter România S.A. Cuza Vodă street, 99-105 540306 Târgu-Mureş, România VAT number: RO1200929 Bank details: account IBAN: RO36RNCB0188034961780018 SWIFT: RNCBROBU Banca Comerciala Romana S.A. Tg.Mures Romania. Yours sincerely, Lidia Dracea Head of Regulatory Affairs Department Page 2/2 99-105 CUZA VODĂ ST. • 540306 TÂRGU-MUREŞ • ROMANIA V.A.T. NO.: RO1200929 • REG. NO. T.R.O.: J26/15/91 TEL.: +40 - 265 - 264.067 • FAX: +40 - 265 - 268.875 • E-MAIL: [email protected]