Prefix —Please choose an option—Mr.MrsDoctorProfessor
Information on the main applicant Date of birth Sex MaleFemale
Nationality —Please choose an option—AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelIvory CoastItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe
Your country —Please choose an option—AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelIvory CoastItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe
In what capacity is the application submitted ? IndividualStructureCompanyOrganisationUniversity
Type LaboratoryUniversityCompanyOthers
Sector PublicPrivate
How did you hear about the Prix Galien Africa ? Social networksWebsitePressOther
Name of the project / Product / Applicant Date of the Marketing Authorisation (MA) dating from December 31, 2016 at the latest
Is it a team effort ? NoYes
Date of birth Sex MaleFemale Nationality —Please choose an option—AllemandeAfghaneAlbanaiseAlgerienneAmericaineAndorraneAngolaiseAntiguaise et barbudienneArgentineArmenienneAustralienneAutrichienneAzerbaïdjanaiseBahamienneBahreinienneBangladaiseBarbadienneBelizienneBelgeBeninoiseBhoutanaiseBielorusseBirmaneBissau-GuinéenneBolivienneBosnienneBotswanaiseBresilienneBritanniqueBruneienneBulgareBurkinabeBurundaiseCambodgienneCamerounaiseCanadienneCap-verdienneCentrafricaineChilienneChinoiseChyprioteColombienneComorienneCongolaiseCostaricaineCroateCubaineDanoiseDjiboutienneDominicaineDominiquaiseEgyptienneEmirienneEquato-guineenneEquatorienneErythreenneEspagnoleEst-timoraiseEstonienneEthiopienneFidjienneFinlandaiseFrançaiseGabonaiseGambienneGeorgienneGhaneenneGrenadienneGuatemaltequeGuineenneGuyanienneHaïtienneHelleniqueHondurienneHongroiseIndienneIndonesienneIrakienneIrlandaiseIslandaiseIsraélienneItalienneIvoirienneJamaïcaineJaponaiseJordanienneKazakhstanaiseKenyaneKirghizeKiribatienneKittitienne-et-nevicienneKossovienneKoweitienneLaotienneLesothaneLettoneLibanaiseLiberienneLibyenneLiechtensteinoiseLituanienneLuxembourgeoiseMacedonienneMalaisienneMalawienneMaldivienneMalgacheMalienneMaltaiseMarocaineMarshallaiseMauricienneMauritanienneMexicaineMicronesienneMoldaveMonegasqueMongoleMontenegrineMozambicaineNamibienneNauruaneNeerlandaiseNeo-zelandaiseNepalaiseNicaraguayenneNigerianeNigerienneNord-coréenneNorvegienneOmanaiseOugandaiseOuzbekePakistanaisePalauPalestiniennePanameennePapouane-neoguineenneParaguayennePeruviennePhilippinePolonaisePortoricainePortugaiseQatarienneRoumaineRusseRwandaiseSaint-LucienneSaint-MarinaiseSaint-Vincentaise-et-GrenadineSalomonaiseSalvadorienneSamoaneSantomeenneSaoudienneSenegalaiseSerbeSeychelloiseSierra-leonaiseSingapourienneSlovaqueSloveneSomalienneSoudanaiseSri-lankaiseSud-africaineSud-coréenneSuedoiseSuisseSurinamaiseSwazieSyrienneTadjikeTaiwanaiseTanzanienneTchadienneTchequeThaïlandaiseTogolaiseTonguienneTrinidadienneTunisienneTurkmeneTurqueTuvaluaneUkrainienneUruguayenneVanuatuaneVenezuelienneVietnamienneYemeniteZambienneZimbabweenne
Country —Please choose an option—AfghanistanAfrique du SudAlbanieAlgérieAllemagneAndorreAngolaAnguillaArabie SaouditeArgentineArménieAustralieAutricheAzerbaidjanBahamasBangladeshBarbadeBahreinBelgiqueBélizeBéninBiélorussieBolivieBotswanaBhoutanBoznie-HerzégovineBrésilBruneiBulgarieBurkina FasoBurundiCambodgeCamerounCanadaCap-VertChiliChineChypreColombieComoresRépublique du CongoRépublique Démocratique du CongoCookCorée du NordCorée du SudCosta RicaCôte d’IvoireCroatieCubaDanemarkDjiboutiDominiqueEgypteEmirats Arabes UnisEquateurErythréeEspagneEstonieEtats-Unis d’AmériqueEthiopieFidjiFinlandeFranceGabonGambieGéorgieGhanaGrèceGrenadeGuatémalaGuinéeGuinée BissauGuinée EquatorialeGuyanaHaïtiHondurasHongrieIndeIndonésieIranIraqIrlandeIslandeIsraëlitalieJamaïqueJaponJordanieKazakhstanKenyaKirghizistanKiribatiKoweïtLaosLesothoLettonieLibanLiberiaLiechtensteinLituanieLuxembourgLybieMacédoineMadagascarMalaisieMalawiMaldivesMaliMalteMarocMarshallMauriceMauritanieMexiqueMicronésieMoldavieMonacoMongolieMozambiqueNamibieNauruNepalNicaraguaNigerNigériaNiouéNorvègeNouvelle ZélandeOmanOugandaOuzbékistanPakistanPalauPalestinePanamaPapouasie Nouvelle GuinéeParaguayPays-BasPérouPhilippinesPolognePortugalQatarRépublique centrafricaineRépublique DominicaineRépublique TchèqueRoumanieRoyaume UniRussieRwandaSaint-Christophe-et-NiévèsSainte-LucieSaint-MarinSaint-Vincent-et-les GrenadinesIles SalomonSalvadorSamoa OccidentalesSao Tomé et PrincipeSénégalSerbieSeychellesSierra LéoneSingapourSlovaquieSlovénieSomalieSoudanSri LankaSuèdeSuisseSurinameSwazilandSyrieTadjikistanTaiwanTanzanieTchadThailandeTimor OrientalTogoTongaTrinité et TobagoTunisieTurkménistanTurquieTuvaluUkraineUruguayVanuatuVaticanVénézuelaVietnamYemenZambieZimbabwe
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What sector are you working in ? —Please choose an option—Pharmaceutical ProductsBiotechnology ProductsPhytotherapyProduits de diagnosticMedical Technology (medical device, diagnostic, etc.)Others
For which award category are you applying ? Best Pharmaceutical ProductBest Traditherapy ProductBest Biotechnology ProductBest medical technology or digital solution (medical device, diagnostic, e-health, telemedicine, patient records, etc.)
Description of the innovation and /or discovery
How does it contribute to the improvement of the human condition ?
What is its impact on the African continent ?
Documents to be attached :
Application letter (maximum one page)
CV (maximum two pages) and legalized copy of diplomas for individual applications
Summary of the institution description for institutional applications (maximum one page)
Full description of the product or device and its impact on the African continent (maximum two pages)
Marketing authorisation for the product or device
Other relevant document :
I read and accept the PGA charter I read and accept the PGA appeal
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