punjab pharmacy council, lahopre - punjab pharmacy council, lahore
punjab pharmacy council, lahopre - punjab pharmacy council, lahore
punjab pharmacy council, lahopre - punjab pharmacy council, lahore
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
PUNJAB PHARMACY COUNCIL, LAHORE<br />
(Established under Pharmacy Act, 1967)<br />
Application Form for Registration as PHARMACIST on Register “A”<br />
1. Name (Block Letters) ___________________________________________________<br />
2. Father’s Name: _______________________________________________________<br />
3. Permanent Address: ___________________________________________________<br />
4. Professional Address: __________________________________________________<br />
5. Qualification (with year and division obtained) and Experience___________________<br />
____________________________________________________________________<br />
6. Roll No. ________________ Session_______________ Held in _________________<br />
7. Name of College ______________________________________________________<br />
8. Name of University ____________________________________________________<br />
9. Date of Birth _______________________ Place of Birth _______________________<br />
10. National Identity Card No. ______________________ Nationality________________<br />
11. Mark of Identification ___________________________________________________<br />
12. The prescribed Fee of Rs. _____________________________ has been remitted by<br />
Bank Draft No. __________________________________ Dated: _______________<br />
Or Cash Receipt No. ______________________________ Dated: _______________<br />
Phone No. _______________<br />
Signature of Applicant<br />
Attested<br />
Photograph to<br />
be Pasted by<br />
the Applicant<br />
English ____________________________<br />
Urdu ______________________________<br />
Dated: _____________________<br />
Following documents must be submitted/attached with the application form:<br />
1. 4 photographs attested by Dean/Chairman/Professor of the Faculty concerned.<br />
2. 2 Photostat copies of Degree attested by Dean/Chairman/Professor or the Faculty<br />
concerned.<br />
3. 2 specimen Signature duly attested by Dean/Chairman/Professor or the Faculty<br />
concerned.<br />
4. 2 Photostat copies of National Identity Card attested by Dean/Chairman/Professor or<br />
the Faculty concerned.<br />
5. 2 Photostat copies of I, II, IIIrd, IVth and final year result Cards attested by<br />
Dean/Chairman/Professor or the Faculty concerned.<br />
6. Registration Fee Rs. 1000/-<br />
7. Fee for Degree verification for as prescribed/required by the University Concerned.<br />
8. Character Certificate from any Professor or the Faculty.<br />
9. An affidavit attested from Oath Commissioner/Notary Public/Grade 18 Officer on<br />
Non Judicial paper of Rs.20/- indicating specimen overleaf.<br />
10. Attested Photo copies of Matric & FSc certificate.<br />
11. An NOC from Provincial Council incase of other province.<br />
NOTE:<br />
(i) Fee for Certificate of Registration of Pharmacist…………………… Rs. 1000/-<br />
(ii) Fee for Duplicate Certificate of Registration ……………………….. Rs. 1000/-<br />
(iii) Renewal Fee ……………………………………………………………Rs. 1000/-
AFFIDANIT<br />
I, _______________________________________________S/o___________________________________________<br />
Cast _____________________________________Resident of ____________________________________________<br />
Tehsil ________________________________District _________________________________do hereby Solemnly<br />
affirm and declare as under:-<br />
1. I passed Pharm - D/M. Pharmacy M. Phill. Pharmacy Examination in the Year _____________________________<br />
Roll No. _________________ from the university _______________________________________________________<br />
2. That the University ____________________ issued my B. Pharmacy / M.Pharmacy /M.Phill Pharmacy<br />
Degree No. __________________ Dated ________________________ Which is genuine one.<br />
3. That my National Identify card No.--------------------is genuine one<br />
4. That I have never been granted registration certificate by any of the provincial<br />
5. Pharmacy <strong>council</strong> in Pakistan, Neither I have applied for the same elsewhere.<br />
6. That I have never been convicted by any court of law for an offence involving moral Turpitude.<br />
7. That I have never been declared unsound by any court of law.<br />
That as stated above are true to the best of my knowledge and belief.<br />
VERIFICATION DEPONENT<br />
Verified on oath this _______________________<br />
Day of _________________ at _________________<br />
That the contents of this affidavit are true to the best of my<br />
Knowledge and belief and nothing have been concealed.<br />
DEPONENT