application for registration of premises under section 13

DEPARTMENT OF HEALTHDRUG OFFICETRADERS LICENSING AND COMPLIANCE DIVISION4ARoom 2550, 25/F, Wu Chung House, 213 Queen's Road East,Wan Chai, Hong Kong,Tel. 2961 8026 Fax: 3904 1225CHECKLISTApplication for Registration of Premises of an Authorized Seller of PoisonsPlease submit this checklist with the following documents.questions below, please provide a written explanation.If you answer “No” to anyHave you submitted Yes No(1) A completed application form? □ □(2) Copy of Business Registration Certificate? □ □(3) (a) For limited companies :(i) Copy of Certificate of Incorporation and(ii) Copy of Directors’ List (e.g. “Form AR1” from CompaniesRegistry or for, newly formed limited companies,photocopy of a full set of “Form NC1” or “Form NC1G”)?(b) For companies run by sole proprietorship :Copy of “Form 1(a)” from the Business Registration Office?OR□□OR(c) For companies run by partnership :Copy of “Form 1(c)” from the Business Registration Office?(4) A list including name(s) in English and Chinese, Hong Kong IdentityCard number(s) and posts of the sole proprietor/ partners/ directors andstaff?(5) A signed declaration of each owner (i.e. sole proprietor or partner) ordirector, and each staff member indicating whether he/she has been anowner, a director or an employee of other trader(s) of western medicines(i.e. importer/exporter, retailer, wholesaler or manufacturer, regardless ofwhether the trader is still in business)? [If so, please list out the relevantinformation, including the English name(s) of the trader(s) and the periodinvolved.]?(6) Statement of qualifications and relevant experience of the soleproprietor/ partners/ directors and all staff members?□□□□□□(DO 12/2013)