FDA Medical Device Registration Form

To export Medical to the United States, US FDA Medical Facility Registration is required. The FDA accepts the facility address from the DUNS database. To begin the procedure, please upload the DUNS number and address proof next page.

How to obtain DUNS?

Name *

Full Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

FDA Registration Number

DUNS Number *

For more details visit the First page.

DUNS Number & Address Proof - Upload here >

Click or drag a file to this area to upload.

Contact Person Name *

Job Title *

Email *

Phone No *

Other Business Names

Other (explain)

US Importer Name

FDA REGISTRATION NUMBER

DUNS NUMBER

Address

Address Line 1

Address Line 2

City

State

Zip Code

PROPRIETARY NAME (1) *

COMMON NAME *

DEVICE CLASS

DEVICE CODE

510 (K) NUMBER

PROPRIETARY NAME (2)

COMMON NAME

DEVICE CLASS

DEVICE CODE

510 (K) NUMBER

PROPRIETARY NAME (3)

COMMON NAME

DEVICE CLASS

DEVICE CODE

510 (K) NUMBER

PROPRIETARY NAME (4)

COMMON NAME

DEVICE CLASS

DEVICE CODE

510 (K) NUMBER

PROPRIETARY NAME (5)

COMMON NAME

DEVICE CLASS

DEVICE CODE

510 (K) NUMBER

PROPRIETARY NAME (6)

COMMON NAME

DEVICE CLASS

DEVICE CODE

510 (K) NUMBER

PROPRIETARY NAME (7)

COMMON NAME

DEVICE CLASS

DEVICE CODE

510 (K) NUMBER

PROPRIETARY NAME (8)

COMMON NAME

DEVICE CLASS

DEVICE CODE

510 (K) NUMBER

PROPRIETARY NAME (9)

COMMON NAME

DEVICE CLASS

DEVICE CODE

510 (K) NUMBER

PROPRIETARY NAME (10)

COMMON NAME

DEVICE CLASS

DEVICE CODE

510 (K) NUMBER

PROPRIETARY NAME (11)

COMMON NAME

DEVICE CODE

DEVICE CLASS

510 (K) NUMBER

PROPRIETARY NAME (12)

COMMON NAME

DEVICE CLASS

DEVICE CODE

510 (K) NUMBER

PROPRIETARY NAME (13)

COMMON NAME

DEVICE CLASS

DEVICE CODE

510 (K) NUMBER

PROPRIETARY NAME (14)

COMMON NAME

DEVICE CODE

DEVICE CLASS

510 (K) NUMBER

PROPRIETARY NAME (15)

COMMON NAME

DEVICE CLASS

DEVICE CODE

510 (K) NUMBER

Name the Person Submitting the Form *

Email *

FDA Medical Device Registration Form

Annual US Agent Fee (Medical Device)