WORLD HEALTH ORGANIZATION
Permissions and Licensing
20, Avenue Appia
CH - 1211 Geneva 27 - Switzerland
Application for a licence to use the ICD-O codes
in a product that is to be sold / licensed
Company Name :
Parent Company :
Address :
City :
State :
Post Code :
Country :
Web site :
http://www.
Contact Person :
Tel :
Title :
Fax :
E-mail :
I confirm that the information submitted as part of my application is accurate and
complete to the best of my knowledge. I agree to notify the World Health
Organization if this information changes.
Signature :
Title :
Name in Full :
Please post or fax the completed application to :
Mr Ian Coltart
Permissions and Licensing
World Health Organization
20, Avenue Appia
CH-1211 Geneva 27
Switzerland
Tel : + 41 22 791 3822
Fax : + 41 22 791 4806
ICD-O-3-2004
Date :
WORLD HEALTH ORGANIZATION
Permissions and Licensing
20, Avenue Appia
CH - 1211 Geneva 27 - Switzerland
Description of intended use
Please note that the English version of ICD-O-3 is not currently available
electronically.
Which of the following methods will you use for distribution of your
product (please tick where appropriate)
Magnetic Media
Optical Media
Internet
Other (please explain)
Name/s of the product/s to be included in the licence :
Please describe the features of each product, the concept of the
product and how it is intended to be used :
How many of the codes and descriptions do you intend to use ? Do
you intend to use the morphology codes and terms ?
How do you propose to use the ICD-O codes and descriptions in the
ICD-O-3-2004
WORLD HEALTH ORGANIZATION
Permissions and Licensing
20, Avenue Appia
CH - 1211 Geneva 27 - Switzerland
product/s ? How will you make the codes available to your users ?
What added value does your product/s offer to users of ICD-O ?
Does your software provide data validation ie the ability to provide
specific diagnosis information on the basis of sex and age ?
Scope of Licence
Names of countries where the product/s will be distributed :
Describe the target market for your product/s
ICD-O-3-2004
WORLD HEALTH ORGANIZATION
Permissions and Licensing
20, Avenue Appia
CH - 1211 Geneva 27 - Switzerland
Please provide additional information on how your product/s are
priced and how they will be sold or licensed to your customers ie
annual fee. Please indicate the price in each case, and whether this is
per user, per CPU, per site or another category.
Please indicate the anticipated volumes of sales (approximate):
What is the target distribution date ? If currently distributed, please
give initial date of distribution :
Are you planning to distribute your product through indirect sales
channels ? If yes, please provide additional information on the
channels to be used.
ICD-O-3-2004
WORLD HEALTH ORGANIZATION
Permissions and Licensing
20, Avenue Appia
CH - 1211 Geneva 27 - Switzerland
If your product is to be distributed via the internet, please include
details of how you propose to use this to medium to distribute your
products eg online download, online access to hosted services etc.
How will you control access to the product and what levels of security
does your web site offer ?
Does your web site carry any form of advertising ?
Yes
No If yes, please provide more details.
Please provide a summary of your company's activities ?
ICD-O-3-2004