Form 19 - Application For Grant Or Renewal Of A Licence To Sell, Stock, Exhibit Or Offer For Sale, Or Distribute Drugs Other Than Those Specified In Schedule X
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1FORM 19
[See Rule 59(2)]
Application for grant or renewal of a 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 sale by wholesale/retail drugs specified in
Schedule C and C(1) and excluding those
Specified in Schedule X* and /
or drugs other than those
specified in Schedule 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 registered pharmacist / competent person 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 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.
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