AUTHORISATION CERTIFICATE APPLICATION FORM
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APPLICANT FACILITY / ORGANISATION
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(1) Name of the Facility / Organisation : |
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(2) Tax Office No: |
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(3) Address : |
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(4) Postcode : |
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(5) City : |
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(6) Country : |
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(7) Phone : |
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(8) Faks : |
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(9) Web address : |
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REPRESENTATIVE OF THE APPLICANT FACILITY/ORGANISATION
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(1) Name of Representative : |
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(2) Surname of the Representative : |
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(3) Address : |
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(4) Postcode : |
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(5) City : |
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(6) Country : |
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(7) Phone : |
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(8) Faks : |
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(9) E-Mail : |
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REQUESTED DOCUMENT
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1. INTERNATIONAL HEALTH TOURISM HEALTH FACILITY AUTHORISATION CERTIFICATE |
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2. INTERNATIONAL HEALTH TOURISM INTERMEDIARY ORGANISATION AUTHORISATION CERTIFICATE |
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(*) Please indicate your request with (X). |
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DECLARATION AND SIGNATURE OF THE APPLICANT
We accept the provisions and conditions of the Regulation on International Health Tourism and Tourist Health and we will fulfil our obligations, we will pay the administrative fines imposed after the inspections to be carried out by the Ministry within 30 days at the latest, our organisation will be responsible for the consequences of delays and incorrect transactions arising from the incomplete delivery of the additional administrative and technical documents requested in relation to the application by us and by the personnel assigned on behalf of the Ministry and the person / persons declared as representative in this application form, We undertake that we will accept the results to be recorded for all kinds of work and transactions to be carried out in relation to the certification procedures that are the subject of the application, and that we will provide all kinds of convenience to the personnel in charge on behalf of the Ministry during the examination of the authorisation certificate criteria.
We confirm that we are aware that using the facility / organisation certification document before the certification procedures related to the document we have applied for are completed and our rights to use the document in this regard are granted, will be considered as deliberate illegal use of the certification mark and our certification application will be affected.
Within the framework of the information given above, we request that our application for the International Health Tourism Authorisation Certificate in the facility / organisation we legally own be evaluated in accordance with the provisions of the Regulation on International Health Tourism and Tourist Health.
Name :
Date :
Signature :
Stamp :
NOTE: Attach the Application Documents in Annex-3/B to this form.
APPLICATION DOCUMENTS
Documents to be submitted by the health facility:
- A copy of the applicant institution's licence / temporary licence and activity permit issued by the Ministry,
- Trade registry certificate.
- Document indicating that it has received a minimum score of 85 points from the last health quality assessment.
- Documents showing that an international health tourism unit has been established, language proficiency certificates and monthly premium and service certificates of the personnel whose number and language proficiency are specified in Article 6 of the Regulation
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Documents to be submitted by the intermediary organisation:
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