Declaration for Importation of MedicationFor Dubai 2019 world Para Athletics Championship

984026 Name of Country 984026 Name of Team Leader 984026 Name of Chief Physician 984026 Phone 984026 Address 984026 E-mail

Category

Name of Nationally Authorize

dMedicatio

n

Main Ingredient for

Medicationpiecebox

Quantity

doping Control

GeneralMedicatio

nNarcotic

psychotropic

Drugs Non

Controlled

Drugs

Controlled Drugs

prohibited

Drugs

Drugs prohibited

inCompetitio

n

Drugs prohibited

inparticular

sport

I hereby declare the above medication for our team to be imported for the Dubai 2019 World Para Athletics Championships

Dateddmmyyyy Chief Physician Name SignatureNote- The details must be filled in English on this given form For Doping control General Medication Narcotics and psychotropic Drugs

(Yellow Background) please place a in the relative box and if more space is needed please feel free to use additional forms accordingly

- Please fill the category box as injection pill spray non-medication etc Doping control must be filled in accordance to the WADA 2019 prohibited list

World Para Athletics Championship-Dubai 2019 Tel +971 4 2988205Address AlQusais1 Behind Stadium Metro Station Fax +971 4 298 8459POBox 20990 Dubai UAE Email medicaldxb2019dcdorgae

Caution The Form must be submit by 1st Oct 2019 and the left over drugs must be re-exported out from Dubai directly after the completion of the GamesSubmit to

World Para Athletics Championship-Dubai 2019 Tel +971 4 2988205Address AlQusais1 Behind Stadium Metro Station Fax +971 4 298 8459POBox 20990 Dubai UAE Email medicaldxb2019dcdorgae

Caution The Form must be submit by 1st Oct 2019 and the left over drugs must be re-exported out from Dubai directly after the completion of the GamesSubmit to

World Para Athletics Championship-Dubai 2019 Tel +971 4 2988205Address AlQusais1 Behind Stadium Metro Station Fax +971 4 298 8459POBox 20990 Dubai UAE Email medicaldxb2019dcdorgae