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FORM

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  • This  application form has been developed based on the Terms of Reference (TORs) for the Coalition of Interested Parties, a World Health Organization (WHO) Network for Regulatory Systems Strengthening, Annex II: Application process, December 2020.
State actor or Non-state actor
Organization address
Name of focal person
Name of focal person
Title
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  • PROPOSED LEVEL OF ENGAGEMENT
Level of engagement
Targetetd regulatory functions
Targeted medical products
Source(s) of funding

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  • CHECKLIST OF INFORMATION / DOCUMENTS TO BE SUBMITTED

    For an application to be considered, the applicant will be required to submit the detailed application and all supporting materials/documentation as they relate to the criteria to become a participant/observer in the CIP Network. 
     
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  • TERMS OF SERVICE

    TERMINATION OF PARTICIPATION

    In terms of Section 7.6 of the TORs, each participant in the Network has the right to withdraw from participation in the Network at any time, subject to providing WHO with at least three (3) months’ prior written notice and to the orderly conclusion of any ongoing activities. WHO also has the right to terminate the participation/involvement of any participant of the Network at any time, upon providing written notice thereof to such participant. 

    TERMINATION OF ACTIVITIES OF THE NETWORK

    In terms of the Section 18 of the TORs, WHO may terminate the activities of the Network at any time upon providing the participants at least sixty (60) days’ prior written notice thereof. Notwithstanding the termination of the Network’s activities, the provisions of these Terms of Reference which are, by their nature, intended to survive such termination will do so indefinitely.

    DECLARATION

    I/We, the nominated focal person/s and representative/s for the applicant named above, hereby declare the fulfilment of the applicable eligibility criteria set forth in the CIP TORs, as well as the WHO’s rules, regulations, policies, procedures and practices including, without limitation, WHO’s Framework for Engagement with Non-State Actors (FENSA)  with respect to applications submitted by Non-State Actors (NSAs).
Agreed to and accepted by the Undersigned as of the date of submission of the Application Form

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  • CONFIDENTIALITY UNDERTAKING

    1.    The World Health Organization (WHO) has established a WHO network for regulatory systems strengthening at the regional, national and country levels, named the “Coalition of Interested Parties, WHO Network for Regulatory Systems Strengthening” (hereinafter, the “Network”).

    2.    In connection with the Network, participants and observers in the Network may gain access to confidential and/or proprietary information, documents and other materials which are disclosed by WHO and/or other third parties collaborating in the Network (including, without limitation, participants, observers, national regulatory authorities and Ministries of Health) and which are clearly stated or marked by such disclosing party(ies) to be confidential (“collectively, “Confidential Information”). To safeguard the confidentiality of such Confidential Information, each participant and observer in the Network (including, without limitation, the Undersigned) is required to sign the Undertaking set forth in this document. 

    3.    The Undersigned hereby undertakes to treat the Confidential Information as confidential and proprietary to WHO and/or third parties collaborating in the Network, and to use the Confidential Information solely for purposes of carrying out the activities, meetings and recommendations of the Network at the global, regional and/or country levels (collectively, the “Purpose”), and no other purpose. The Undersigned also agrees to take all reasonable measures to ensure that Confidential Information is not used, copied, disclosed or otherwise transmitted, whether in whole or in part, by or on behalf of the Undersigned to any third parties; except for third parties who have a need to know the Confidential Information for the Purpose and who are bound by obligations of confidentiality and restrictions on use which are substantially similar to those contained in this Undertaking. 

    4.    The Undersigned shall not be bound by any confidentiality obligations or restrictions on use contained herein if and to the extent that the Undersigned is clearly able to demonstrate that the Confidential Information: (a) was known to the Undersigned prior to its disclosure to by WHO or any third parties collaborating in the Network; or (b) was in the public domain at the time of disclosure to the Undersigned by WHO or any third party collaborating in the Network; or (c) becomes part of the public domain through no fault of the Undersigned; or (d) becomes available to the Undersigned from a third party not in breach of any legal obligations of confidentiality or restrictions on use. 

    5.    The Undersigned undertakes not to communicate any of the materials, discussions, outputs, results or recommendations of the Network or any of its governing bodies or working groups to any third parties, except as authorized in writing by WHO. 

    6.    Upon WHO’s request, the Undersigned shall promptly return to WHO or third parties collaborating with the Network, as applicable, any and all copies of their respective Confidential Information which are then in the Undersigned’s possession or control.

    7.    The obligations of the Undersigned pursuant to this Undertaking shall survive the termination of the Undersigned’ s participation in the Network. 

    8.    Any dispute relating to the interpretation or application of this Undertaking shall, unless amicably settled, be subject to a conciliation. In the event of failure of the latter, the dispute shall be settled by arbitration. The arbitration shall be conducted in accordance with the modalities to be agreed upon by the parties or, World Health Organization Organisation mondiale de la Santé 16 in the absence of agreement, with the rules of arbitration of the International Chamber of Commerce. The parties shall accept the arbitral award as final. 

    9.    Nothing contained in or relating to this Undertaking shall be deemed or construed as a waiver of any of the privileges and immunities enjoyed by WHO, or as submitting WHO to any national court jurisdiction. 
    Agreed to and accepted by the Undersigned as of the date set forth below. 
     
Agreed to and accepted by the Undersigned as of the date of submission of the Application Form
1. Is your entity, or was your entity over the last four years, part of the tobacco or arms industries (as defined above)?
2. To the best of your entity’s knowledge, is your entity, or has your entity over the last four years, engaged in activities that are aimed at furthering or supporting the interests of the tobacco industry? This includes, but is not limited to, supply contracts, contract work, services and lobbying2. To the best of your entity’s knowledge, is your entity, or has your entity over the last four years, engaged in activities that are aimed at furthering or supporting the interests of the tobacco industry? This includes, but is not limited to, supply contracts, contract work, services and lobbying.
3. To the best of your entity’s knowledge, does your entity currently, or did your entity over the last four years, have any other association or relationship with the tobacco industry (as defined above). This includes in particular investment interests (other than general mutual funds or similar arrangements whereby your entity has no control over the selection of the investments), commercial business interests, the provision or receipt of financial and/or other support.

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  • If you have answered yes to any of the above or are unable to answer one or more questions, please provide a general statement of explanation.

    Please note that the WHO Secretariat reserves the right to request additional information from your entity in this regard. 

    By providing this statement, your entity commits to promptly inform WHO of any change to the above information and to complete a new statement that describes the changes.
     
Agreed to and accepted by the Undersigned as of the date of submission of the Application Form