Dated: .....................

To
The Registrar,
Telangana State Pharmacy Registration Tribunal,
Nampally, Hyderabad,
Telangana.
Sub: Application for Registration to First Register Regarding.
Sir,
1. I Mr/Miss/Mrs.....................
S/D/W/o.......have
passed

Diploma/B.

Pharm/M.

Pharma/Pharm.D/PHD

course

from

the

College...........................................
from........

University/State

Board

of

Technical

Education AP/Telangana State/other state Technical board.

2. I am presently living and/or working in the addresses given below.
3. I am a member of AP Pharmacy Council with Registration No .. dated
..
4. I submit my willingness for registration in first Register of Telangana State for
formation of Telangana Pharmacy Council.
5. I have enclosed Indian Postal Order(IPO) worth of Rs. 10 bearing no: _________
dated : ____________
Thanking you,
Yours faithfully,

Present Residential Address:

Name:
Registration No.
Mobile No.
Email ID:

Present Working Address:

(Medical Shop/College/Company etc)

Enclosures:
1. APPC Registration Certificate Xerox copy.
2. Pass Book renewal Xerox copy.
3. Address proof Xerox copy (Aadhaar card/Driving License/Bank Pass Book/Voter
Card/Ration Card/Passport)
4. IPO worth of Rs. 10/-