South African Health Products Industry
Individuals click here to certify

 Company Details

Company Name
Physical Address
Address Line 1  *   Surburb
Province * Postal Code
Postal Address
Postal Line 1 *   Surburb
Province * Postal Code
Website address
Toll free or customer number
Fax Number
Company registration number * Vat number
In the event of your Company being a subsidiary company, please list the name and address of the parent company
If your company previously traded under another name, please list the name:
Are you a foreign multinational or local manufacturer or distributor? Does your company perform local manufacturing/packaging?
Does manufacture include secondary packaging? If you are a local company are you listed on the JSE?
Nationality of your home company?  
List your membership of any trade association/s:
Managing Director Chief Executive Officer
Personal Assistant/Secretary * Telephone number(PA)
Email Address(PA) *      
If admitted to Membership, the following persons will be the MCA representative: If Other - Provide Details
Direct phone number Cell phone number
Direct fax number Email
Compliance Officer:  Direct Phone Number
Cell Phone Number Fax Number
Responsible Pharmacist / Person who approves and signs all the advertising material Direct Phone Number
Cell Phone Number Fax Number

E2 Solutions
Visa and Master card