This is the text extract for Schedule 4: Proposal form for the supply of paroxetine, browse documents here.

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Schedule 4: Proposal form An electronic version of this form is available on disc from PHARMAC or on PHARMAC’s website at <www.pharmac.govt.nz>. You should expand the boxes as necessary. [Supplier to insert date ] Chief Executive C/- Martin Szuba PHARMAC PO Box 10-254 (or for courier delivery: Level 1, Old Bank Chambers 98 Customhouse Quay) Wellington New Zealand Dear Sir/Madam Proposal for the supply of Paroxetine In response to your request for proposals (RFP) dated 14 March 2003, we put forward the following proposal in respect of paroxetine. Set out below is further information in support of our proposal. (a) Our contact details: Name of supplier Contact person Address Phone Facsimile Email address

(b)

Details of pharmaceutical presentation: Chemical name Strength (e.g. 20mg) Form (e.g. tablet) Brand name Pack size (e.g. 30’s) Packaging type (e.g. blister)

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(c)

Key features of our proposal:

(d)

Information relating to pricing ($NZ, GST exclusive), including any related conditions or proposed terms affecting cost for PHARMAC (e.g. price in return for sole subsidised supply, reference price protection, risk sharing mechanisms, etc.):

(e)

Evidence of market approval and any other required consents: Date of market approval (please attach copy of Medsafe Gazette notice) [OR Date of submission of dossier (please attach confirmation from Medsafe that dossier has been submitted)] [OR Expected date of dossier submission to Medsafe] Insert any other consents required for pharmaceutical

(f)

Information about our ability to ensure the continuity of supply of the pharmaceutical:

(g)

Information about our previous supply performance and relevant expertise:

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(h)

Proposals/suggestions (e.g. pricing, risk sharing arrangements, etc) regarding the pharmaceutical not expressly identified in this RFP that we would like PHARMAC to consider as part of our proposal:

(i)

Reasons why PHARMAC should accept our proposal:

(j)

Additional information that PHARMAC should consider when evaluating our proposal:

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