ESG Appendix H: Sample Letters of Non-Repudiation Agreement
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A letter of Non-Repudiation Agreement for digital signatures must be submitted to the FDA prior to registering as a transaction partner for the FDA ESG. The letter must be submitted in paper form (preferably on company letterhead) and signed with a traditional handwritten signature. The letter must be sent to*:
La Misha Fields
Electronic Submissions Gateway
U.S Food and Drug
Administration
3WFN, Room 1234
12225 Wilkins Avenue
Rockville, MD 20852
The following two letters are provided as samples for a Letter of Non-Repudiation Agreement. The information in square brackets [ ] will be provided by the submitter.
SAMPLE LETTER #1
[Company Letterhead]
[Today's Date]
La Misha Fields
Electronic Submissions Gateway
U.S Food and Drug Administration
3WFN, Room 1234
12225 Wilkins Avenue
Rockville, MD 20852
Re: Electronic Signatures
Dear Sir or Madam:
Pursuant to Section 11.100 of Title 21 of the Code of Federal Regulations, this is to certify that [Company Name], [Company Address], intends that electronic signatures executed by our employees, [List of employee names] are the legally binding equivalent of traditional hand-written signatures.
Sincerely yours,
[Hand-written signature]
[Company Representative Title]
[Employee Name #1]: _________ [Hand-written signature of employee #1]
[Employee Name #2]: _________ [Hand-written signature of employee #2]
[Employee Name #3]: _________ [Hand-written signature of employee #3]
[etc]
SAMPLE LETTER #2
[Company Letterhead]
[Today's Date]
La Misha Fields
Electronic Submissions Gateway
U.S Food and Drug Administration
3WFN, Room 1234
12225 Wilkins Avenue
Rockville, MD 20852
Re: Electronic Signature Certificate Statement
To Whom It May Concern:
Pursuant to Section 11.100 of Title 21 of the Code of Federal Regulations, this is to certify that [Company Name], intends that all electronic signatures executed by our employees, agents, or representatives, located anywhere in the world, are the legally binding equivalent of traditional hand-written signatures.
Sincerely yours,
[Hand-written signature]
[Name of Company Representative]
[Company Representative Title]
*If using USPS, do NOT use Priority Mail Express.