FORM 19 [See Rule 59(2) ] Application for grant or renewal of a 40a[Licence to sell, stock, exhibit or offer for sale, or distribute] drugs other than those specified in Schedule X 1. I/We .................................. hereby apply for Licence to sell by wholesale/retail drugs specified in Schedules C and C(1) excluding those specified in Schedule X* and/or drugs other than those specified in Schedules C,C(1) and X to the Drugs and Cosmetics Rules, 1945* and also to operate a pharmacy on the premises situated at .................................. 2. $The sale and dispensing of drugs will be made under the personal supervision of the qualified persons namely: .......................................(Name) ....................................... (Qualification). .......................................(Name) .......................................(Qualification). 3. Categories 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 ....................................... * Delete whichever is not applicable. $ To be deleted if drugs will be sold only by wholesale. + Required only if products requiring special storage are to be sold.
