AA Locums Pharma AA Locums Pharma Licensed UK Wholesale

Customer Qualification • Authorised Healthcare Providers Only

Supply Request Application

Under MHRA Good Distribution Practice (GDP) guidelines, AA Locums Pharma is required to qualify every customer before supply commences. This application captures the information our Responsible Person needs to assess your organisation. Allow approximately 5–10 minutes.

AA-GDP-LOG-008A · Customer Qualification Form (Digital Submission)

Regulatory notice

AA Locums Pharma supplies medicinal products only to verified and authorised customers — including pharmacies, wholesalers, hospitals, clinics, and other licensed healthcare providers. Supply will not commence until our Responsible Person has independently verified the documentation submitted below. Submissions are retained for a minimum of five years in accordance with EU GDP Guidelines (2013), Chapter 4.

Step 1 of 4 — Customer Details

1.

Customer Details

Information about your organisation. All fields marked with * are required.

The legal registered name of your organisation.

Full registered address including postcode and country.

Primary point of contact for this application.

Business email address — generic inboxes (e.g. info@) will slow verification.

Include country code, e.g. +44 7XXX XXXXXX

Primary regulatory licence — e.g. MHRA WDA(H) reference, GPhC Pharmacy Registration Number, or equivalent authorisation in your jurisdiction.

For UK organisations only.

2.

Documentation

Supporting documentation will be requested by our Responsible Person after initial review of your application. Please be prepared to provide the documents listed below in PDF, JPG, or PNG format (max 10MB per file).

  • ·

    Customer Licence (WDA(H) or Pharmacy Registration) Required

    Copy of your current regulatory licence. We will independently verify against the issuing authority's register.

  • ·

    GDP Certificate Optional

    If your organisation holds a current GDP certificate. Not required for end-user pharmacies and clinics.

  • ·

    Company Registration (Companies House or equivalent) Optional

    Certificate of incorporation or equivalent registration document.

  • ·

    Proof of Address Required

    Recent utility bill, lease, or bank statement dated within the last three months.

  • ·

    Account Application Form Optional

    Your organisation's internal vendor or account application form, if applicable.

  • ·

    Credit Check Authorisation Optional

    If you wish to apply for credit terms.

Sensitive documents are stored in encrypted form and accessed only by AA Locums Pharma's Responsible Person and authorised quality team.

3.

Operational Detail

Help us understand your supply requirements. This information supports our internal risk assessment and is not a commitment to supply.

0 / 2000 characters (minimum 50)

4.

Confirmation

Please confirm the following before submitting your application.

Applications are reviewed by our Responsible Person within two business days. Urgent enquiries: +44 7462 134119.