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REGISTRATION TO THE DOCTORS’ AREA
Form to access scientific information for Doctors.
thDecember 1992, n. 541 (Implementation of the 92/28/ECC Directive) concerning the advertising of medicines meant for human use.

PHITOGEN HOLDING Spa
NOTIFICATION in accordance with Section 13 of Legislative Decree
n. 196 of 30 June 2003



REQUEST OF CREDENTIALS NECESSARY FOR ACCESS
(The required fields are marked with an asterisk*)

PERSONAL DECLARATION OF CERTIFICATION
(Self-certification pursuant to Article 46 Legislative Decree of 28th December 2000, n. 445)

PERSONAL DATA
Username*:

Password*:

Email*:

Name*:

Surname*:

Place of birth:

Date of birth*:


PERSONAL DATA RELATING TO THE PROFESSION
Professional Domicile*:

Town/City*:

Postal Code*:

Country*:

Phone:

Year of graduation*:

Specialization*:


NOTICE
The authentication credentials ascribed to the Doctor by Phitogen Holding spa, in quality of site Proprietor and Data Controller, are strictly personal. By sending in this Form, the Doctor undertakes to use the credentials in an exclusively personal way and to keep them reserved and not to communicate them to anyone else.

DECLARATION OF CONSENT
In compliance with Article 23 Legislative Decree of 30th June 2003, n. 196 (Privacy Code)

By filling in this Form and submitting it to Phitogen Holding s.p.a., in quality of site Proprietor and Data Controller, I expressly declare that:
- I have read the Privacy Notification referred to by this Form, and provided for by Article 13 of the Italian Privacy Code;
- I have understood its content;
- I guarantee the truthfulness of the personal Data collected by Phitogen Holding s.p.a. through this Form and communicated by me on a voluntary basis by filling in the fields;
- I give my consent, in compliance with Article 23 as above, to my personal Data contained in this Form, to be proceeded by Phitogen Holding s.p.a., in quality of Data Controller, who undertakes to proceed them exclusively with the scope to offer to me the activity of Scientific Information this Restricted Area is dedicated to.
- I give my consent, according to the afore-mentioned Article 23, my Restricted Area web pages Access Data to be proceeded as to carry out a better Scientific Information activity by Phitogen Holding s.p.a.
I consent to proceed my personal Data:

YES     NO