[
FORM 19 ]
[ See Rule 59 (2)]
Application for grant
or renewal of a license to sell, exhibit or
offer For sale, or distribute drugs other than
those specified in Schedule X 1.
I/We________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
___________________________________________________________________________
_______________________ hereby apply for license
to sell by wholesale/retail drugs specified
in Schedule C and 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 qualified
persons 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 account
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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