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