Health Department FORM 19-B [See Rule 67-A] Application for licence to sell, stock or exhibit [or offer]42b for sale, or distribute Homoeopathic medicines 1. I/We.........of ......... hereby apply for a licence to sell *wholesale By--------------- Homoeopathic medicine on the premises situated *retail at ..... +2. The sale and dispensing of Homoeopathic medicines shall be made under the personal supervision of the following competent person in-charge. Name ......... 3. A fee of rupees......... has been credited to the Government under the head of account......... Date ......... Signature......... * Delete whichever is not applicable. + To be deleted if Homoeopathic medicines will be sold by wholesale.
