User Registration -
Step 1
1
Login Information
2
Agent Information
3
Registration Pharmacist
4
Other Department Responsible
5
Local Safety Responsible
6
Backup Of Local Safety Responsible
Provide your login details.
Username
*
Password
*
Very Strong
Weak
Password must be at least 8 characters long and include at least one lowercase letter, one uppercase letter, one digit, and one special character
Confirm Password
*
Email
*
Send Verification Code
Verification Code
*
We sent a verification code to your email
Agent legally responsible for placing the product on the market in Jordan.
Agent name in English
*
Agent name in Arabic
*
Manager First name
*
Manager Middle name
Manager Last name
*
Office Address Line 1
*
Office Address Line 2
Office Address Line 3
Postal Zip Code
City
*
Country
*
Select your agent country
Jordan
E-mail
*
This E-mail address will be used to get in touch with you
Mobile No.
*
This number will be used to get in touch with you via sms
Phone
*
Ext
Fax
Legally Responsible for Registration Process in JFDA
First Name
*
Middle Name
Last Name
*
Mobile No.
*
This number will be used to get in touch with you via sms
E-mail
*
This E-mail address will be used to get in touch with you
Person legally responsible for communication with other department in JFDA
First Name
*
Middle Name
Last Name
*
Mobile No.
*
E-mail
*
Local Safety Responsible (LSR)
First Name
*
Middle Name
Last Name
*
Mobile No.
*
E-mail
*
Tasks and Responsibilities
*
Backup Of Local Safety Responsible (LSR)
First Name
*
Middle Name
Last Name
*
Mobile No.
*
E-mail
*
Tasks and Responsibilities
*
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