::: Panacea Biotec ::: >> Investor Zone > Business Associates

Home >> Investor Zone > Business Associates > In Licensing

In Licensing Opportunity Submission Form
Title :	Mr. Ms. Dr.
First Name :	*
Last Name :
Designation :	*
Company :	*
Annual Turnover :	USD
Address :
City :
Postal Code :
Country:
E mail :	*
Telephone :
Fax :
Website :

Nature Of your offering

New Chemical Entity
Low Molecular Wt. Compound	Defined Natural Product
Antibody	Other Protein
Other
Drug Delivery System
Controlled release Systems	Biorhythm based delivery systems
Microemulsions	Targeted vesicular systems
Mucoadhesive nanoparticles	Taste Masking
Osmotically controlled DDS	Gastroretentive systems
Pulmonary DDS	Transdermal Drug Delivery System
Biodegradable DDS	Monoclonal Antibody DDS
Polymer/membrane DDS	Liposome Delivered DDS
Diffusion Delivery System	Prodrug Delivered Drug
Coatings Delivery System	Magnetic Targeted Carriers Delivered Drug
Site Selective DDS	Transmucosal DDS
Buccal Delivery System	Microencapulated DDS
Vaginal Delivery System	Patch Delivery System
Occular Delivery System	Pegnology DDS
Rectal Delivery System	Monolithic Dispersion DDS
Erosion DDS	Devices
Other
Vaccine
Name of Vaccine
Other Information
Natural Product
Active Ingredient
Source Plant
Other Information
Antibody
Related Information
Device
Pulmonary Drug Delivery devices
Transdermal Drug Delivery devices
Non Invasive Injectable device
Artery cath drill
Diagnostic Devices
Skin Contact Adhesive
Implants
Others

Is your offering patented?	Yes No
If yes, please provide details:

Sr No.

Edit

Delete

Country

Patent No

Patent Type

Expiry Date

Are you the inventor or co-inventor?

Yes No

What is the molecular target of your offering?

Labeled indication you are offering for your product:

Are all indications available for licensing?

Yes No.

If not, please indicate which indications are excluded:

What is the potency of the compound in relevant in vitro assays?

[max 50 words]

What is the potency of the compound when given to animals? (Mention type of administration.)

[max 50 words]

Is toxicological data available?

Is clinical data available?

Yes, No

If yes, at what phase:

Phase 1 Phase 2 Phase 3 Phase 4

ADR Profile:

[max 50 words]

Any Death Reported?

Yes. No

If yes, please provide details:

Other Details