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["附件2"]
["重庆市九龙坡区人民医院医疗设备公开需求调查报名表（需求调查编号：JLPRMYY-SB-？）"]
["报名时间：   年  月  日"]
["设备名称",null,null,"规格型号"]
["报价单价（元）",null,null,"质保期（年）",null,"使用年限（年）"]
["报名企业\n名称",null,null,"代理级别"]
["品牌/生产厂家",null,null,"生产企业规模"]
["报名人/授权人",null,null,"联系方式",null,"电话：\n邮箱："]
["以下资料如提供请打√"]
["序号","报名资料",null,null,"证照有效期",null,"是否提供证件"]
[1,"报价单"]
[2,"产品技术白皮书"]
[3,"彩页"]
[4,"代理商《营业执照》、《医疗器械经营许可证》"]
[5,"厂家《营业执照》、《医疗器械生产许可证》"]
[6,"所投产品有效的《医疗器械产品注册证》"]
[7,"法人授权书及被授权人身份证复印件"]
[8,"承诺书"]
[9]
["报名人签名：             （如提供其他未列明资料请自行补充登记）"]
["现场提供加盖公章纸质版报名资料1份和推荐资料（报价单+推荐书+产品技术白皮书+彩页）6份"]