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Confidential Request for Access to Dossier Materials

This form must be completed by any entity seeking access to restricted materials related to PLPC-DB™, including, but not limited to, the CTD dossier, STIP registry, SAP audits, PET–FDG subgroup data, and strategic documentation.
All information will be handled in strict confidence and used solely to evaluate NDA eligibility.

I. ORGANIZATIONAL INFORMATION

• Institution / Company Name:

• Jurisdiction of Incorporation

• Entity Type

• Primary Contact Name

• Position / Title:

• Phone Number

• Email Address

II. REQUESTED PURPOSE (Select all that apply):

III. DECLARATION

By submitting this form, the requester declares:
1. That they are authorized to represent the entity named above.
2. That the information provided is accurate and complete.
3. That they understand PLPC-DB™ is a structurally closed, non-public asset, and that access is granted solely under confidentiality protocols.
4. That they agree not to disseminate or disclose any portion of the information received unless expressly authorized.

Signature:

Name:

Date:

Please return this form to: Department of Oncopathology – OGRD Alliance
plpc@ogrdalliance.org
Subject: “NDA Request – [Institution Name]”
A member of our team will respond within 48 hours with documentation access instructions.