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Wednesday, 01 September 2010 05:30

Download Application Form for Grant or Renewal of Licence

Download forms for state: Andaman and Nicobar Island
Form Details
StateAndaman and Nicobar Island
DepartmentDirectorate of Health Services
TitleApplication Form for Grant or Renewal of Licence
LanguageEnglish
Document Size42.5 KB
Text of the PDF document(for quick reference)
Form - 19 ( See Rules 59 (2)) Application for grant or renewal of a License ( to sell, stock, exhibit or offer for sale or distribution) of drugs other than those specified o in Schedule - x. 1. I / we .................................................here by apply for license to sell by wholesale/ retail drugs specified in schedule C and C(1) excluding those specified in schedule X and / or drug other than those specified I Schedule C, C (1) and X to the Drug and Cosmetics rules , 1945 and also to operate a pharmacy on the premises situated at ........................................................ ............................. 2. The sale and dispensing of drug will be made under the personal supervision of a qualified person,, namely:- (Name)...................................(Qualification) (Name)....................................(Qualification) 3. Category of drugs to be sold. 4. Particulars for special storage accommodation. 5. A fee of rupees ............................................... Has been credited to the Government account under the head of account.................................................... . Date: Signature:
Last Updated on Friday, 17 December 2010 05:30
 

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