FORM
19-AA
[See Rule 62C]
Application for grant or renewal of a license
to sell, stock or exhibit or offer For sale
by wholesale, or distribute] drugs from a motor
vehicle.
1. I/We ___________________ of _________________
hereby apply for [license to sell, stock or
exhibit or offer for sale by wholesale, or distribute]
drugs specified in Schedules C and C(1) and
/or drugs other than those specified in Schedule
C and Schedule C(1) from the vehicle bearing
registration No. _______________ the Motor Vehicles
Act Act, 1939.
2. Categories of drugs to be sold / distributed—
______________________________
______________________________
______________________________
3. A fee of rupees ____________________ has
been credited to Government under the head of
account
_____________________________
_____________________________
_____________________________
*4. Particulars of the storage accommodation
for the storage of drugs specified in Schedules
C and C(1) on the vehicle referred to above.
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. |
