Application form and Guidance notes on how to apply for registration ...

<strong>Application</strong> <strong>form</strong> <strong>and</strong> 

<strong>Guidance</strong> <strong>notes</strong> on how to 

apply for registration as a 

pharmacy technician with 

current GPhC approved 

qualifications <strong>and</strong> work 

experience 

Pharmacy Technician Registration, 

General Pharmaceutical Council 

129 Lambeth Road, London SE1 7BT 

info@pharmacyregulation.org 

www.pharmacyregulation.org 

tel: 0203 365 3400 

GPhC Oct 2012 

Applicants with the currently approved GPhC qualifications <strong>and</strong> work experience

From 1 July 2011 you cannot work as a pharmacy technician or refer to yourself as a pharmacy technician 

unless you are registered with the GPhC. (Please note that those who have submitted an application 

under the gr<strong>and</strong>parenting requirements, by 5pm on Thursday 30 th June 2011, may continue to work 

whilst their application is being processed). 

This registration guidance should provide you with all the in<strong>form</strong>ation you need about how to register. 

Please read this carefully before contacting the General Pharmaceutical Council (GPhC). 

You can submit your application no sooner than 4 weeks before you are due to complete the relevant 

work –based experience. For example if you are applying with UK qualifications only (with no overseas 

qualification) <strong>and</strong> you started the 2 years’ work experience on 1 September 2009, the earliest you can 

submit your application is during the first week of August 2011. 

Please note the application you submit must be complete <strong>and</strong> include all supporting documents <strong>and</strong> 

qualification certificates correctly certified by a solicitor. Incomplete applications will be returned to you 

<strong>and</strong> where we require additional in<strong>form</strong>ation this may delay your registration. If you do submit an 

application before you complete the relevant work based experience your supervising pharmacist must 

complete the additional declaration confirming the date when the period will finish. 

Completed <strong>form</strong>s must be sent to 

PHARMACY TECHNICIAN REGISTRATION, GPhC, 129 LAMBETH ROAD, LONDON, SE1 7BT 

The GPhC enters applicants onto the register on the 1 st <strong>and</strong> 15 th date of each month. 

Please note that if we receive your application on or after 1 July 2011 you will not be able to work as a 

pharmacy technician until you have a registration number. 

You will not have access to your registration number until the date that you are due to register (as of 12.01 

a.m. on that day). You can obtain your registration number from the GPhC website by doing a pharmacy 

technician search <strong>and</strong> entering your name. 

A few weeks after you have been registered, a letter will arrive confirming your registration. This will 

confirm the part of the register in which you have been registered, your name as it appears on the Register, 

your registration number, the date of entry on the Register <strong>and</strong> the period that your entry is valid. 

The GPhC does not issue certificates. Your registration number is proof of registration with the GPhC. 

NOTE: YOU ARE NOT REGISTERED UNTIL YOU APPEAR ON THE REGISTER. IF WE RECEIVED YOUR 

APPLICATION ON OR AFTER 1 JULY 2011 AND YOU DO NOT APPEAR ON THE REGISTER YOU CANNOT WORK 

OR CALL YOURSELF A PHARMACY TECHNICIAN. 

GPhC Oct 2012 


Preparing <strong>and</strong> completing your application 

1. Read all the guidance carefully. 

2. Complete the application <strong>form</strong> in BLOCK CAPITALS <strong>and</strong> mark boxes clearly to answer the 

questions. 

3. Check the guidance if you are not sure how to answer a question. Additional guidance documents 

are listed below. Contact us if you are still not sure how to answer a question. 

4. Using the Registration application checklist, collect together all your certificates <strong>and</strong> passport. 

See below for alternatives to current passports. 

5. If you are applying <strong>and</strong> have a non-UK pharmacy qualification as well as the 2 approved UK 

qualifications, there are additional documents you will need to send. 

6. Check that all the names on your documents are spelt the same way <strong>and</strong> any changes in name can 

be tracked. If there are variations see below for advice. 

7. Arrange to visit a UK practising solicitor to obtain certified photocopies of the original documents 

you need to submit. 

8. Arrange for your photograph <strong>and</strong> section 9 of the <strong>form</strong> to be signed (your countersigning pharmacist 

or pharmacy technician can sign if they have known you for at least 2 years). 

9. Arrange to meet with the pharmacist/pharmacy technician who will countersign your application 

<strong>form</strong>. 

10. Before meeting your pharmacist/pharmacy technician, check you have answered all the questions 

in the application <strong>form</strong>. Using the checklist, check you have provided all the necessary copies of 

documents. 

11. Once you have signed section 7 yourself, your countersigning pharmacist or pharmacy 

technician should check your application thoroughly before signing section 8 A of your <strong>form</strong>. 

12. Send your completed application to us as instructed on the checklist. 

13. It is important that your application is double checked before sending it to us. 

14. If any in<strong>form</strong>ation or documents are missing we will return your application <strong>and</strong> your registration will 

be delayed. We will charge a £47 administration fee if we have to return applications for missing 

in<strong>form</strong>ation more than once. 

GPhC Oct 2012 


Additional guidance documents <strong>and</strong> <strong>form</strong>s 

The following documents can be downloaded from our website www.pharmacyregulation.org 

<strong>Guidance</strong>: 

St<strong>and</strong>ards of conduct, ethics <strong>and</strong> per<strong>form</strong>ance 

St<strong>and</strong>ards for continuing professional development 

Criteria for the initial registration as a pharmacy technician 

<strong>Guidance</strong> on registration with the GPhC <strong>and</strong> Fitness to Practise: This advises how to answer the 

questions on fitness to practise. 

Good character assessment framework: This lists the areas we will take into consideration when 

you have declared a conviction or police caution. 

Health assessment framework: This lists all the relevant points we will take into consideration 

when you have declared matters concerning your health. 

Additional <strong>form</strong>s: 

Something to declare <strong>form</strong>. To be completed if you have declared a conviction, caution or 

health matter. 

GPhC Oct 2012 


Registration application checklist 

<strong>Application</strong> <strong>form</strong> (including photograph certification) 

Payment <strong>form</strong> 

Birth certificate – certified copy (<strong>and</strong>/or statutory declaration) 

Marriage certificate/s (if you are married) – certified copy (or statutory declaration) 

Certificates for the competency based <strong>and</strong> knowledge based qualifications <strong>and</strong> non-UK qualification 

(if applicable) – certified copies 

Passport – certified copy or alternative documents 

Photograph – attached to section 9 of the application <strong>form</strong> 

Stamped self addressed postcard for confirmation that we received your application 

If you have a non-UK pharmacist or pharmacy technician qualification <strong>and</strong> want to use evidence of 

this to reduce the 2 year qualifying period of work experience required you must arrange for the 

following documents to be sent direct to the GPhC 

Academic transcript relating to your qualification. This must be sent to the GPhC by your awarding 

institution (college/university) 

Evidence that you are registered or otherwise eligible to practise as a pharmacist or pharmacy 

technician in the country of your qualification. You must arrange for the regulatory authority or 

awarding institution to confirm this direct to the GPhC. If the profession is regulated in your country 

of qualification this is normally in the <strong>form</strong> of a letter of good st<strong>and</strong>ing or certificate of current 

professional status. 

Send your completed <strong>form</strong>s <strong>and</strong> other documents to 



129 Lambeth Road, 

London SE1 7BT 

We will only accept complete applications. Both declarations (see sections 7 <strong>and</strong> 8) must be signed <strong>and</strong> 

supporting documents included with your application <strong>form</strong>. 

We will not accept liability for any loss as a result of completed applications not reaching us. 

Recorded delivery is recommended. 

Keep a copy of your application in case the original does not reach us. 

A stamped addressed postcard must be enclosed with your application for us to acknowledge 

receipt. 

<strong>Application</strong>s can take as long as 4 weeks to process. This can be much longer if you have 

disclosed a fitness to practise matter. 

GPhC Oct 2012 


How to complete the application <strong>form</strong> 

Section 1 Personal details 

Questions 1.2 <strong>and</strong> 1.3 Names 

The name you register under must be the same as the name you intend to practise under. This will be your 

registered name. 

If you wish to be registered in a different name from that printed on your birth certificate you must provide 

either: 

A certified copy of your marriage certificate or other acceptable documentation (for instance a Deed 

Poll or certificate of Civil Partnership), or 

A statutory declaration completed in front of a solicitor. A statutory declaration <strong>form</strong> is provided 

at the end of the application pack. 

Your name on all the documents you submit must be exactly the same – letter for letter, word for word. If 

there are any variations in your name within or between documents you must provide a declaration of those 

variations on the Statutory Declaration <strong>form</strong>, sworn before a solicitor registered <strong>and</strong> in good st<strong>and</strong>ing, with 

the Law Society of Engl<strong>and</strong> <strong>and</strong> Wales or Scotl<strong>and</strong> who is practising in one of those jurisdictions. 

Please tell us if you change your name. If you change your name whilst we are processing your application, 

you must notify us in writing <strong>and</strong> send a certified photocopy of the relevant document (for instance a 

statutory declaration or marriage certificate). If you change your name after you are registered, you must 

notify us in writing within one month of the date of change with a certified copy of the relevant document. 

Question 1.5 <strong>and</strong> 1.6 Your address 

Your registered address must be the address where you live, as this is the address we will use when we write 

to you. 

We will not publish this address on the publicly available Register. Please provide us with an e-mail address. 

We will contact you by e-mail if we require additional in<strong>form</strong>ation or documents. 

You must keep your contact details up to date. If you change your home or e-mail address you must 

notify us as soon as possible. If you fail to keep your contact details up to date <strong>and</strong> we cannot contact you 

for clarification this will delay your application. 

GPhC Oct 2012 


Section 2 <strong>Application</strong> type 

Please tell us what type of applicant you are by ticking the appropriate box on the application <strong>form</strong>. 

Section 3 Previous applications <strong>and</strong> Registration with other bodies 

Question 3.1 Previous applications 

You must tell us if you have previously: 

registered with the Royal Pharmaceutical Society of Great Britain (RPSGB) or the GPhC in the past as 

a pharmacist or pharmacy technician 

applied for registration with the RPSGB or GPhC as a pharmacist or pharmacy technician 

undertaken or applied to RPSGB or GPhC for pre-registration training. 

If any of the above applies, you must also tell us: 

the date of your application 

the type of application (for instance, was it made through transitional provisions, as an international 

application or were you applying to register as a pharmacist) 

any previous registration or pre-registration numbers or application numbers you may have had 

any other in<strong>form</strong>ation you think is relevant (for instance, if you began an application but then 

withdrew). 

Questions 3.2 

You must tell us if you are, or have been, registered with any other regulatory bodies either in the UK or 

overseas. If you are registered with more than one body please provide details on a separate sheet. If 

you are relying on your non-UK qualification for registration you must arrange for a letter of confirming 

your registration status <strong>and</strong>/or eligibility to practise to be sent directly to us by the issuing authority. 

Section 4 Fitness to Practise 

We define a ‘conviction’ as a finding, in criminal proceedings in the UK (or elsewhere), that a person has 

committed the offence alleged. You do not need to include road traffic offences where you were offered the 

option of paying a fixed penalty. This is even if you refused the option of paying the fixed penalty <strong>and</strong> were 

convicted of the offence by a court. 

You must tell us if you have been involved in any legal or disciplinary proceedings including any that have 

resulted in a caution or if you have any problems with your physical or mental health that may impair your 

ability to practise. Failure to do so may result in misconduct allegations at a later stage. 

You must tick either yes or no to questions 4.1 to 4.7. 

If you have answered yes to any of the questions you must complete the Something to declare <strong>form</strong>. 

GPhC Oct 2012 


Section 5 Education <strong>and</strong> training 

Approved UK qualifications 

You must hold: 

One of the competency qualifications 

<strong>and</strong> 

One of the knowledge qualifications 

The eligible qualifications are listed in Annex A of the Criteria for initial registration as a pharmacy 

technician. 

Only include the UK qualifications listed in Annex A which you hold <strong>and</strong> not pharmacy/dispensing 

assistant or medicines counter assistant qualifications. 

For each of the qualifications, write the exact title of the qualification, the date you started your course <strong>and</strong> 

the date you were awarded your qualification. 

If you hold a non-UK pharmacy qualification, in addition to the 2 approved UK qualifications, <strong>and</strong> wish to rely 

on this to reduce the 2-year qualifying period of work experience you must tell us: 

the title of this qualification, 

the name of the awarding institution <strong>and</strong> 

the country where your qualification was obtained. 

GPhC Oct 2012 


Section 6 Qualifying periods of work experience 

You need to provide evidence of having completed a minimum of two years relevant work-based experience in 

the UK under the supervision, direction or guidance of a pharmacist to whom you have been directly 

accountable for not less than 14 hours per week. Within this 2 year period there must be at least 1260 hours 

of work experience in total <strong>and</strong> there must be a minimum of 315 hours in each of the two years. This duration 

in hours excludes sickness absence, maternity/paternity leave <strong>and</strong> holidays. (Please see section 7 of the GPhC 

Criteria for initial registration as a pharmacy technician on the GPhC’s website for further in<strong>form</strong>ation). 

You can include work experience, during your pharmacy technician courses <strong>and</strong> up to 3 months before the 

start of the course, provided that during this time you have been working <strong>and</strong> carrying out the role of a preregistration 

trainee pharmacy technician in the United Kingdom, Isle of Man or Channel Isl<strong>and</strong>s under the 

supervision, direction or guidance of a pharmacist to whom you have been directly accountable. This is 

because within 3 months of commencing contracted relevant work experience as a pre-registration trainee 

pharmacy technician you must commence or register for one of the two required qualifications listed above. 

If there are gaps in your work experience, e.g. due to maternity leave, you will need to give a brief explanation 

in a covering letter. 

If there are variations in your hours over the two years, please provide details on a separate sheet. 

If you have told us that, you hold a non- UK pharmacy qualification <strong>and</strong> that you have completed 

One of the competency based qualifications <strong>and</strong> 

One of the knowledge based qualifications (listed in Annex A of the Criteria for initial registration as a 

pharmacy technician) 

You are not required to complete the full 2 years relevant work experience in the UK if you provide evidence: 

that you have relevant work-based experience in the UK as a pre-registration trainee pharmacy 

technician under the supervision, direction or guidance of a pharmacist to whom you have been 

directly accountable for not less than 14 hours per week whilst you have been completing the two 

approved UK qualifications. You can include work experience, during your pharmacy technician 

courses <strong>and</strong> up to 3 months before the start of the course, provided that during this time you have 

been working <strong>and</strong> carrying out the role of a pre-registration trainee pharmacy technician in the 

United Kingdom, Isle of Man or Channel Isl<strong>and</strong>s under the supervision, direction or guidance of a 

pharmacist to whom you have been directly accountable; <strong>and</strong> 

that you hold a non-UK pharmacist or pharmacy technician qualification. You must arrange for 

your awarding institution to send direct to the GPhC the academic transcript relating to your 

qualification; <strong>and</strong> 

that you are registered or otherwise eligible to practise as a pharmacist or pharmacy technician in 

the country of your qualification. You must arrange for the regulatory authority or awarding 

institution to confirm this direct to the GPhC. If the profession is regulated in your country of 

qualification this is normally in the <strong>form</strong> of a letter of good st<strong>and</strong>ing or certificate of current 

professional status. 

GPhC Oct 2012 


Section 7 Declaration by applicant 

You must sign <strong>and</strong> date the declaration. The GPhC register is divided into parts. Part 2 is for registration as a 

pharmacy technician. 

Fraudulently procuring an entry in the pharmacy technicians’ register will be treated as misconduct <strong>and</strong> may 

result in removal from the Register. 

Section 8 A Declaration by countersigning pharmacist or pharmacy technician 

This section must be completed by a practising pharmacist/pharmacy technician with current UK registration 

who is in good st<strong>and</strong>ing. 

The pharmacist’s/pharmacy technician’s registration number must be provided so we can verify their details. 

The countersignatory is asked to declare that to the best of their knowledge the in<strong>form</strong>ation given in the 

application <strong>and</strong> in any supporting in<strong>form</strong>ation is true <strong>and</strong> accurate, <strong>and</strong> relates to you. 

If you are sending your application in advance of having completed the relevant period of work 

experience Section 8B must be completed by the pharmacist under whose supervision, direction or 

guidance you have been working in the UK <strong>and</strong> to whom you have been directly accountable. 

Section 9 Photograph certification guidance 

You must provide one recent passport sized photograph. This must be signed on the back by an appropriate 

official. The photograph must be attached to the photograph certification page of your application <strong>form</strong>. 

The person who signs the photograph (the counter signatory): 

Must be a professional person, or a person of st<strong>and</strong>ing in the community. Examples include a 

pharmacist, registered pharmacy technician, a UK registered solicitor or a licensed Medical 

Practitioner. If you have any questions about who is an appropriate official contact us. 

Must have known you for at least 2 years 

Must not be related to you by birth or marriage. Neither should they be in a personal relationship 

with you e.g. husb<strong>and</strong> <strong>and</strong> wife, nor live at your address. 

Must write on the back of the photograph the words ‘I certify that this is a true likeness of (give full 

name of the applicant)’ They must also sign <strong>and</strong> date the back of the photograph. 

They must also complete the photograph certification page of the application <strong>form</strong> giving their full 

name, occupation <strong>and</strong> sign <strong>and</strong> date the <strong>form</strong>. 

GPhC Oct 2012 


Requirements for the photograph 

The photograph must be: 

Taken within the last month 

In colour 

Against an off-white, cream or light grey plain background so your features are clearly 

distinguishable 

Printed on low-gloss, plain-white photo-quality paper 

Undamaged, for example, by creases from paperclips 

Of you on your own 

In sharp focus <strong>and</strong> clear 

Have a strong definition between the face <strong>and</strong> background 

The photograph must show: 

No shadows 

You facing forwards, looking straight towards the camera 

A neutral expression, with your mouth closed (no obvious grinning, frowning or raised eyebrows) 

Your eyes open <strong>and</strong> clearly visible (no sunglasses or heavily tinted glasses <strong>and</strong> no hair across your 

eyes) 

No reflection or glare on your glasses, <strong>and</strong> the frames should not cover your eyes 

Your full head, without any head covering, unless it is worn for religious beliefs or medical reasons 

Nothing covering your face. Please ensure that nothing covers the outline of your eyes, nose or 

mouth. 

Section 10 Equality Monitoring Form 

You are not required to provide this in<strong>form</strong>ation if you do not wish to do so but would be helpful if you do. 

Section 11 Payment for application for registration as a pharmacy technician 

When you apply to register with us you need to pay the appropriate fees 

An application fee. This covers our costs for checking the documents you have provided 

The first entry fee. This covers our costs for putting <strong>and</strong> maintaining your name on the 

register for 12 months from the date of entry. 

GPhC Oct 2012 


You need to submit both the application fee <strong>and</strong> the first entry fee with your application. 

Please note you: 

must make your payment by credit or debit card as we no longer accept cheque payments. 

should complete the Payment Form included in the application pack providing your card details. 

will not be registered as a pharmacy technician until we have taken the first entry fee payment. 

If you send in your application without the correct fees your application will be returned to you. 

GPhC Oct 2012 


<strong>Guidance</strong> on providing supporting documents 

Certified copies 

We recommend you send certified copies (not the originals) of the following documents: 

Birth certificate 

Marriage certificate or other acceptable document(s) (where appropriate) 

Passport. If you do not have a current passport - see advice below. 

Qualification certificate(s) 

Only UK registered solicitors can certify your documents. The official must write on each photocopy: 

“I certify that I have seen the original document <strong>and</strong> that this is a true copy”, 

sign, 

date <strong>and</strong> 

provide an official solicitor’s stamp. 

No liquid paper amendments or alterations of any other kind are permitted to certified copies. 

Changes in name 

All the names on your birth certificate, passport, qualification certificate <strong>and</strong> application <strong>form</strong> must be exactly 

the same, which means word for word, letter for letter. This includes any middle names or initials you may 

have <strong>and</strong> any changes in spelling or order. 

You must provide documentation to support all changes to your name, for instance a marriage certificate, 

Deed Poll or Certificate of Civil Partnership. If you are not able to do this, you must see a solicitor <strong>and</strong> 

complete the relevant section of the statutory declaration <strong>form</strong>. 

Translations for documents not in English 

Any document that is not written in the English language MUST be accompanied by a translation. 

You must provide the original translation together with a solicitor certified copy of the document which is 

not in English. 

Translations must be carried out by a professional translator. 

GPhC Oct 2012 


The translator must sign <strong>and</strong> date the translation <strong>and</strong> provide their name <strong>and</strong> business address. 

The translator must also certify that they are authorised to translate from the particular foreign language 

into English, <strong>and</strong> that the translation produced is true <strong>and</strong> accurate. The certification must be on the same 

page as the translation or be attached to the translation. 

The translation must be a literal translation NOT an interpretation of the original document. 

All certifications <strong>and</strong> ink stamps on the original document must also be translated. 

Contact your embassy for a list of official translators. 

Applicants without passports 

If you do not have a current passport you should send certified copies of both your: 

UK driving licence, AND 

NHS card or National Insurance card. 

Both the photo card <strong>and</strong> paper part of the driving licence must be provided. The driving licence must be 

current. 

If you do not have a current photo card driving licence you should send: 

NHS card or a National Insurance card (certified copy), AND 

three of the following original documents (we will return them to you by recorded delivery) 

o Bank/building society, credit card or financial statement (such as a pension statement) 

o P45/P60 

o Utility bill 

o TV licence 

o Addressed payslip 

o Council tax or benefit statement 

o CRB disclosure certificate 

All documents must be dated within the last 12 months of the date your application is received by us. 

The details on the document (including address) must be the same as the details on your application <strong>form</strong>. 

GPhC Oct 2012 


Academic Transcripts for overseas qualifications 

An academic transcript is a full transcript of your academic record for your pharmacy qualification. It must 

show the years of study, the subjects you studied <strong>and</strong> the marks you obtained in each examination. It must be 

certified by the relevant officer at the university or academic body. 

Letters of good st<strong>and</strong>ing 

Evidence of being registered should be provided in a Letter of Good St<strong>and</strong>ing or Certificate of Current 

Professional Status issued by the appropriate authority of the country or state in which you originally qualified. 

The certificate should be issued no more than six months before the date that you expect to apply to register. 

If you have practised within the last five years in countries or states other than that in which you qualified you 

are also required to provide a Letter of Good St<strong>and</strong>ing or Certificate of Current Professional Status issued by 

each appropriate authority of every such country or state. 

If you have not maintained your overseas registration, then you are required to obtain a certificate from all of 

the relevant authorities confirming the following: 

That you are no longer registered with that authority, but that the qualification you hold entitles 

you to register AND 

That if you wanted to re-register in the future, then there are no matters of a disciplinary or 

criminal nature existing, <strong>and</strong> no pending disciplinary or criminal investigations, which would 

prevent the authority from re-registering you <strong>and</strong> permitting you to resume practice as a 

pharmacy professional within their jurisdiction. 

What is a Statutory Declaration 

When submitting your registration documents, please bear in mind that the names on your birth certificate, 

qualification certificate, proof of identity document(s) <strong>and</strong> application for registration must be identical in 

every way. That includes any middle names or initials you may have <strong>and</strong> any changes in spelling or order. If the 

names on these documents are not identical, you must see a solicitor <strong>and</strong> complete the relevant sections of the 

Statutory Declaration. Failure to do this will delay your registration. If any of the following apply, you will need 

to see a solicitor to complete a Statutory Declaration: 

You do not have a Birth Certificate or your Birth Certificate is not written in English. COMPLETE 

DECLARATION ‘A’ 

The registration date on the Birth Certificate is not within one year of the date of birth. COMPLETE 

DECLARATION ‘A’ 

You want to register in a name other than that on your Birth Certificate, e.g. additional/dropped names 

or letters. (The name you put on the Statutory Declaration should be identical to that which you put on 

your <strong>Application</strong> for Registration Form.) COMPLETE DECLARATION ‘B’ 

Names on your qualification certificates or Proof of Identity Document(s) are not identical in every way 

to those on your Birth Certificate <strong>and</strong> <strong>Application</strong> for Registration Form. (All names must be identical: 

word for word, letter for letter <strong>and</strong> in the same order. Initials are not acceptable.) COMPLETE 

DECLARATION ‘C’ 

GPhC Oct 2012 


GPhC Oct 2012 


<strong>Application</strong> <strong>form</strong> 

for 

registration as 

a pharmacy 

technician 

THIS APPLICATION FORM IS FOR APPLICANTS APPLYING WITH 

THE CURRENT GPhC APPROVED QUALIFICATIONS AND WORK 

EXPERIENCE. 



129 Lambeth Road, London SE1 7BT 

info@pharmacyregulation.org 

www.pharmacyregulation.org 

tel: 0203 365 3400 

GPhC Oct 2012 


THIS APPLICATION FORM IS FOR APPLICANTS APPLYING WITH THE CURRENT GPhC APPROVED 

QUALIFICATIONS AND WORK EXPERIENCE. 

PLEASE NOTE APPLICATIONS MAY TAKE AT LEAST 4 WEEKS TO PROCESS. 

1. Personal details 

1.1 Title 

Mr Mrs Ms Miss Other (please specify) 

1.2 Surname(s) 

1.3 Forename(s) 

1.4 Date of birth 

1.5 Home Address 

1.6 Postcode 

Country 

1.7 Nationality 

1.8 Home phone Work phone 

1.9 Mobile 

1.10 Email address 

GPhC Oct 2012 


2. Type of application 

2.1 Which application process applies to you 

Please tick one box 

Applicant with approved UK qualifications <strong>and</strong> 2 year qualifying period of work experience 

Applicant with approved UK qualifications <strong>and</strong> evidence of non-UK pharmacy qualification 

<strong>and</strong> qualifying period of work experience 

3. Previous applications <strong>and</strong> Registration with other bodies 

3.1 Have you ever applied previously for registration with the Royal Pharmaceutical Society of Great Britain 

(RPSGB) or the General Pharmaceutical Council (GPhC), either as a pharmacy technician or as a 

pharmacist or undertaken preregistration training with the RPSGB or the GPhC 

If you have answered ‘yes’ to question 3.1 please state your application, registration or preregistration 

number/ type of application/ date of application 

Yes 

No 

3.2 Are you currently or have you previously been registered with any UK statutory health regulatory body 

(any member body of the Council for Healthcare Regulatory Excellence) or a health regulatory body 

outside Great Britain Yes No 

If you have answered ‘yes’ to question 3.2 please give details <strong>and</strong> provide a letter of good st<strong>and</strong>ing 

Name of body 

Registration number 

4. Fitness to practise 

By virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 <strong>and</strong> the Rehabilitation 

of Offenders Act 1974 (Exclusions <strong>and</strong> Exceptions) (Scotl<strong>and</strong>) Order 2003, you are exempt from the 

provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974. Therefore you are not entitled 

to withhold in<strong>form</strong>ation about convictions which for other purposes are spent under the provisions 

of the Act <strong>and</strong> failure to disclose such convictions could result in disciplinary action 

4.1 Has a determination ever been made against you by a regulatory body in the United Kingdom 

responsible under any enactment for the regulation of a health or social care profession to the effect 

that your fitness to practise as a member of a profession regulated by that body is impaired, or a 

determination by a regulatory body elsewhere to the same effect Yes No 

GPhC Oct 2012 


4.2 Do you currently have any problems with your physical or mental health that may impair your ability to 

practise safely <strong>and</strong> effectively or which otherwise impairs your ability to carry out your duties in a safe 

<strong>and</strong> effective manner Yes No 

4.3 Have you previously been convicted or cautioned for a criminal offence in the British Isl<strong>and</strong>s or 

elsewhere (which, if committed in Engl<strong>and</strong>, Scotl<strong>and</strong> or Wales would constitute a criminal offence) or 

have you previously agreed to be bound over to keep the peace by a Magistrates’ Court in Engl<strong>and</strong> or 

Wales Yes No 

Please note that Road Traffic offences in which the person committing the offence has been offered 

the option of paying a fixed penalty (e.g. certain speeding offences etc) will not be treated as a 

conviction for the purposes of registration <strong>and</strong> need not be declared. 

4.4 Have you previously agreed to pay a penalty under section 115A of the Social Security Administration 

Act 1992 (penalty as alternative to prosecution) Yes No 

4.5 Are you currently under investigation by any regulatory body (other than the GPhC) or criminal 

enforcement authority (e.g. police or NHS Counter Fraud Service) in the British Isl<strong>and</strong>s or elsewhere 

Yes No 

4.6 Have you previously accepted a conditional offer under section 302 of the Criminal Procedure (Scotl<strong>and</strong>) 

Act 1995 (fixed penalty: conditional offer by procurator fiscal) or have you previously been subject to an 

order under section 246(2) or (3) of the Criminal Procedure (Scotl<strong>and</strong>) Act 1995 discharging you 

absolutely (admonition <strong>and</strong> absolute discharge) Yes No 

4.7 Have you previously been included by the Independent Safeguarding Authority (also known as the 

Independent Barring Board) barred list (in Engl<strong>and</strong>, Wales or Northern Irel<strong>and</strong>) or the children’s list or 

adult’s list maintained by the Scottish Ministers Yes No 

If you have answered ‘yes’ to any of the questions please provide details on the Something to Declare 

<strong>form</strong> with your application. The ‘something to declare’ <strong>form</strong> is available on our website 

www.pharmacyregulation.org by email to info@pharmacyregulation.org <strong>and</strong> by telephone on 0203 

365 3400. 

GPhC Oct 2012 


5. Education <strong>and</strong> training 

Applicants should provide details of pharmacy technician qualification(s) gained in the United Kingdom. 

Applicants must hold one of the approved competency based qualification <strong>and</strong> one of the approved 

knowledge based qualification <strong>and</strong> provide solicitor certified photocopies of all relevant qualification 

certificates with their application. 

5.1 Title of knowledge based qualification 

5.2 Date commenced (month <strong>and</strong> year) 

5.3 Date awarded (month <strong>and</strong> year) 

5.4 Name of course provider 

5.5 Title of competency based qualification 



5.8 Name of course provider 

5.9 Title of non-UK pharmacy qualification (if applicable) 



5.12 Name of university 

5.13 Country 

GPhC Oct 2012 


6. Work experience 

Provide in<strong>form</strong>ation on your work experience as a pre-registration trainee pharmacy technician. You 

must provide evidence of having completed a minimum of two years relevant work-based experience in 

the UK under the supervision, direction or guidance of a pharmacist to whom you have been directly 

accountable for not less than 14 hours per week. (Please see section 7 of the GPhC Criteria for initial 

registration as a pharmacy technician). During these two years, you must have completed at least 1260 

hours of work experience (excluding sickness absence, maternity leave <strong>and</strong> holidays) <strong>and</strong> at least 315 

hours of work experience in each year. 

You can include work experience during your pharmacy technician courses <strong>and</strong> up to 3 months 

before the start of the course provided that during this time you have been working <strong>and</strong> carrying 

out the roles of a pre-registration trainee pharmacy technician in the United Kingdom, Isle of Man 

or Channel Isl<strong>and</strong>s under the supervision, direction or guidance of a pharmacist to whom you have 

been directly accountable. 

If you have a non-UK pharmacy qualification you have to provide evidence of this (see guidance 

<strong>notes</strong>) <strong>and</strong> of having worked in the UK as a pre-registration trainee pharmacy technician under the 

supervision, direction or guidance of a pharmacist to whom you have been directly accountable for 

not less than 14 hours per week. 

Gaps in work experience - you must tell us if there are any gaps in your work experience, e.g. 

maternity leave, long term sick leave. On a separate sheet or covering letter, give a brief reason for 

the gap <strong>and</strong> start / end date. 

A. Work experience in year 1 

Name <strong>and</strong> address of organisation 

Hours worked per week, 

Provide details on a separate sheet if there is a variation 

Start date (dd/mm/yy) 

End date (if applicable) (dd/mm/yy) 

Job Title 

Main responsibilities / duties 

Name <strong>and</strong> job title of your supervising pharmacist <strong>and</strong> their GPhC registration number 

Contact number of supervising pharmacist 

GPhC Oct 2012 


B. Work experience in year 2 


Hours worked per week 




Job Title 




GPhC Oct 2012 


C. Any additional work experience to complete approved UK qualifications or work experience 

requirement 


Hours worked per week 




Job Title 




Please continue you career history on separate sheets if necessary 

GPhC Oct 2012 


7. Declaration by applicant – This declaration must be completed <strong>and</strong> dated before you 

give your application <strong>and</strong> supporting documents to the countersignatory for checking. 

I declare that: 

7.1 I am applying for registration in Part 2 of the Register <strong>and</strong> I hereby declare that, in accordance with 

Article 20(3) of the Pharmacy Order 2010, I intend to practise as a pharmacy technician in Great Britain, 

the Channel Isl<strong>and</strong>s or the Isle of Man. 

7.2 The in<strong>form</strong>ation that I have provided in this application for registration is complete, true <strong>and</strong> accurate. I 

am also aware that I am under a duty to notify the Registrar of any changes to my name, home address 

or other contact details within one month starting on the day on which the change occurred. 

7.3 I will adhere to the st<strong>and</strong>ards relating to conduct, ethics <strong>and</strong> per<strong>form</strong>ance <strong>and</strong> continuing professional 

development published by the General Pharmaceutical Council. 

7.4 I have in place appropriate indemnity arrangements. 

7.5 I accept that I am under a duty to notify the Registrar if there is any change in the circumstances relating 

to the fitness to practise declaration that I have made within 7 days starting on the day on which the 

event occurred. 

I underst<strong>and</strong> that 

7.6 If I am found to have given false or misleading in<strong>form</strong>ation in connection with my application for 

registration in the Register, this may be treated as misconduct, which may result in my removal from the 

Register. 

Signature 

Date 

Data Protection Statement 

The GPhC is a data controller registered with the In<strong>form</strong>ation Commissioner’s Office. The GPhC makes use of 

personal data to support its work as the regulatory body for pharmacists, pharmacy technicians <strong>and</strong> retail 

pharmacy premises in Great Britain. Data may be shared with third parties in pursuance of the GPhC's statutory 

aims, objectives, powers <strong>and</strong> responsibilities under the Pharmacy Order 2010, the rules made under the Order 

<strong>and</strong> other legislation. Personal data may be processed for purposes including (but not limited to) updating the 

register, administering <strong>and</strong> maintaining registration, processing complaints, compiling statistics <strong>and</strong> keeping 

stakeholders updated with in<strong>form</strong>ation about the GPhC. In<strong>form</strong>ation may be passed to organisations with a 

legitimate interest including universities <strong>and</strong> research institutions. Please note that the GPhC will not share 

your personal data on a commercial basis with any third party. 

GPhC Oct 2012 


8A. Declaration by countersigning pharmacist or pharmacy technician 

This section must be completed by a practising pharmacist or pharmacy technician with current UK 

registration who is in good st<strong>and</strong>ing. 


8.1 I am on the GPhC/PSNI Register 

8.2 I am in good st<strong>and</strong>ing with the GPhC/PSNI 

8.3 I have checked the documents to be submitted <strong>and</strong> confirm that they are all present <strong>and</strong> have been 

enclosed with this application <strong>form</strong> 

8.4 To the best of my knowledge the in<strong>form</strong>ation given in this application <strong>and</strong> in any supporting documents 

is true, complete <strong>and</strong> accurate <strong>and</strong> relates to the applicant. 

8.5 I know of no reason why this applicant should not be registered as a pharmacy technician 

Name (Please print) 


Signature 

Date 

GPhC Oct 2012 


8B. Declaration by supervising pharmacist 

This section must be completed if application submitted prior to completion of the 2 years relevant work 

based experience. 


8.6 I am on the GPhC/PSNI Register 

8.7 I am in good st<strong>and</strong>ing with the GPhC/PSNI 

8.8 The applicant will have complete the relevant period of work experience by: 

(Insert date below as dd/mm/yy) 

8.9 To the best of my knowledge the in<strong>form</strong>ation given above is true <strong>and</strong> accurate <strong>and</strong> relates to the 

applicant. 

8.10 Should I become aware of any changes to the fitness to practise declaration completed by the 

applicant I will notify the GPhC within 7 days of becoming so aware <strong>and</strong> advise the applicant to do 

likewise. I am aware of my professional obligations to do so. 

Name (Please print) 


Signature 

Date 

GPhC Oct 2012 


9. Photograph certification 

This section must be completed by the person who signs the back of the photograph 

9.1 Name 

9.2 Address 

9.3 Country 

9.4 Occupation 

9.5 Phone 

9.6 Email address 

By countersigning this application, you agree that the General Pharmaceutical Council (GPhC) may 

contact you to verify the in<strong>form</strong>ation that you have provided. 

I declare that I have signed the photograph enclosed <strong>and</strong> that I have known 

for 

years <strong>and</strong> the in<strong>form</strong>ation I have provided is correct. 

Please insert no. of years above 

Signature 

Date 

I certify this is a true 

likeness of 

Give applicants full 

name <strong>and</strong> title 

Signature of 

certifying person 

<strong>and</strong> date certified 

Staple certified photograph here 

GPhC Oct 2012 


10. Equality monitoring 

10.1 What is you ethnic group Please tick one 

White 

British Irish Other 

Black or Black British 

Caribbean African Other 

Mixed 

White <strong>and</strong> Black Caribbean 

White <strong>and</strong> Black African 

White <strong>and</strong> Asian 

Other Mixed (please specify) 

Asian or Asian British 

Indian 

Pakistani 

Bangladeshi 

Other Asian (please specify) 

Other ethnic group 

If other please specify 

10.2 What is you gender Please tick one 

Male 

Female 

10.3 What is your sexual orientation Please tick one 

Heterosexual Lesbian / Gay Bisexual 

10.4 What is your religion Please tick one 

None Christian Buddhist Hindu 

Jewish Muslim Sikh Other 

If other please specify 

10.5 Do you consider that you have a disability Please tick one 

Yes 

No 

GPhC Oct 2012 


11. Payment for application for registration as a pharmacy technician 

11.1 Name of applicant 

Charge this card with the sum of (payment by credit card will incur a surcharge of 2%): 

<strong>Application</strong> Fee: 

Debit card: £102 

Credit card (£102 + £2.04 credit card surcharge): £104.04 

£ 1 0 2 0 0 

£ 1 0 4 0 4 

First Entry Fee: 

Debit card: £108 (First Entry Fee) 

£ 1 2 0 

. 

0 0 

Credit card (£108 First Entry Fee + £2.16 credit card surcharge): £122.16 

Please indicate whether you are paying by: 

£ 1 2 2 1 6 

Debit card 

Credit card 

Type of card Please tick one: 

Mastercard Visa Visa Purchasing Visa Delta Maestro Solo 

Card number 

(insert the exact amount 

of digits in your card 

number only) 

CSC number 

(The last 3 digits on the back of the card) 

Valid From Date Expiry Date Issue number 

Issue number for Maestro or Solo cards only. If your card does not have an issue number please enter ‘NA’ in the boxes. 

Name of cardholder # 

Address of cardholder 

The name exactly as it appears on the debit or credit card 

Postcode 

Signature 

To be signed by the cardholder 

Date (dd/mm/yy) 

GPhC Oct 2012 


You need to submit both the relevant application fee <strong>and</strong> the first entry fee with your application. 

The application fee is taken when we receive your application, the first entry fee when your name 

is entered onto the Register. 

The first entry fee covers the costs of maintaining your name on the register of pharmacy 

technicians for twelve months from the date of first entry. 

Please note 

Fees are non-refundable. The GPhC will not accept cheque payments 

An additional £47 administration fee will be levied in the event of an application for registration 

having to be returned to the applicant more than once. 

GPhC Oct 2012 


STATUTORY DECLARATION 

Instructions for completing the appropriate declaration(s) 

You must complete whichever declaration(s) on this page of the <strong>form</strong> is/are applicable to your situation <strong>and</strong> 

the ‘To be completed by the applicant’ section. 

The appropriate declaration(s) on this <strong>form</strong> must be completed by the applicant in the presence of a solicitor, 

who should then complete the ‘Declaration by solicitor’. 

DECLARATION A - Inability to provide a birth certificate OR birth certificate not written in English 

This declaration must be completed if you are unable to provide the GPhC with a copy of your birth certificate 

or if your birth certificate is not written in English. 

Please note: To be acceptable your birth certificate must state your full legal name, date <strong>and</strong> place of birth <strong>and</strong> 

indicate that your birth was registered within 12 months of the date of birth. 

DECLARATION B - Using a name other than that on birth certificate 

This declaration must be completed when you have changed your name to a different one from that on your 

birth certificate or the order in which your names appear on your birth certificate is different from that on 

your <strong>Application</strong> for Registration. Please note that the GPhC requires you to be registered in your full name so 

for registration purposes you cannot drop a name which is present on your birth certificate UNLESS you 

complete this declaration. 

DECLARATION C - If name(s) on supporting documents differ from <strong>Application</strong> for Registration 

All the names on your supporting documents must be identical to the names on your <strong>Application</strong> for 

Registration <strong>and</strong> birth certificate or marriage certificate (if applicable). If they are not identical, you must 

complete this declaration. 

PLEASE NOTE - You may need to complete more than one declaration. 

Declaration A 

Inability to provide birth certificate OR birth certificate not written in English 

I, 

(Insert full name – this must be identical to that on your application for registration) 

of 

(Insert home address) 

do solemnly <strong>and</strong> sincerely declare to the best of my knowledge <strong>and</strong> belief, that at my birth I was given the name 

(Insert your name at the time of your birth) 

On / / in / 

(Insert date of birth DD/MM/YY) (Insert town / country)) 

<strong>and</strong> that I am unable to obtain a certified copy of my birth certificate or my birth certificate is not written in English. 

GPhC Oct 2012 


Declaration B 

Using a name other than that on birth certificate 

I, 

(Insert full name as written on birth certificate) 

of 


do solemnly <strong>and</strong> sincerely declare that since / / 

I have used <strong>and</strong> in future will be known by the name of 

(Insert full name you are now using – this name must be identical to that on your application for registration) 

Declaration C 

If there is a variation in name between documents 

I, 

(Insert full name as written on birth certificate or if no birth certificate, use the name as provided in declaration A) 

of 


declare that all documents submitted with my application for registration including the copy of the qualification certificate 

relate to me <strong>and</strong> that all versions of my name relate to one <strong>and</strong> the same person. 

To be completed by the applicant 

I 

(Insert full name you are now using – this name must be identical to that on your application for registration) 

make the declaration(s) overleaf conscientiously believing the same to be true <strong>and</strong> by virtue of the provisions of the 

Statutory Declarations Act, 1835. 

Signed Date / / 

Declaration by solicitor 

Declared at 

(Insert full name <strong>and</strong> address of solicitor’s premises)* 

This 

day of 

before me 

Signed 

(Insert solicitor’s stamp here) 

GPhC Oct 2012

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