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Application Forms l 2IRS l 2IRS(2)
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shipment of clinical trial investigational products by using the d2m sante/csp 2irs system
please answer the following:

 
Clinical Trial Number/Code :
Site N° :
Name of the site (Investigator's name) :
Treatment Unit nimber:


• Stratification
    Yes No    if yes, please specify the stratium n° :

• I have already sent the confirmation supportive documents for the above clinical supplies shipment :
    Yes No

Warnig : the confirmation supportive documents are to be sent without any delay
by fax to the following number 33(0)4 73 69 89 44
by e-mail to the following e-mail adress: carfeuil @csp-epl.com