APPLICATION FOR REIMBURSEMENT STATUS 2026

1. Click ‘Get Form’ to open the APPLICATION FOR REIMBURSEMENT STATUS in the editor.
2. Begin by filling out the 'Applicant' section. Enter your name, Business ID, contact person, postal address, telephone, fax, and email address.
3. Next, move to the 'Product' section. Provide details about the clinical nutritional product including its name, dosage form, manufacturer, importer, and package size.
4. In the 'Wholesale price' section, input both the valid confirmed wholesale price and your proposed wholesale price in euros.
5. Select the appropriate 'Application type' based on your needs. Specify any diseases under the Government Decree for which reimbursement status is sought.
6. Complete the 'Application appendices' by summarizing justifications for reimbursement status and providing a well-grounded proposal for pricing.
7. Fill in the 'Invoicing' section with relevant invoicing address and contact details.
8. Finally, review all sections for accuracy before signing. Add your signature along with clarification of your signature at the end of the document.

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