FORM-19 (See Rule 59(2))

Application for grant or renewal of a licence to sell, stock, exhibit or offer for sale, or distribute drugs than those specified in Schedule-X

Format of Affidavits

Application Form


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3. *Categories of drugs-


4. #Particulars for special storage accommodation:


Supervisors


The sale dispensing of drugs will be made under the personal supervision of a qualified person(s), namely -
 

Section


Licensee Details


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Pharmacist/Competent Person Details


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Fees to be paid


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Declaration of Employee(s)



Declaration


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