PUNJAB PHARMACY COUNCIL, LAHORE
(Established under Pharmacy Act, 1967)
Attested
Photograph to
be Pasted by
the Applicant
Application Form for Registration as PHARMACIST on Register A
1.
Name (Block Letters) ___________________________________________________
2.
Fathers Name: _______________________________________________________
3.
Permanent Address: ___________________________________________________
4.
Professional Address: __________________________________________________
5.
Qualification (with year and division obtained) and Experience___________________
____________________________________________________________________
6.
Roll No. ________________ Session_______________ Held in _________________
7.
Name of College ______________________________________________________
8.
Name of University ____________________________________________________
9.
Date of Birth _______________________ Place of Birth _______________________
10. National Identity Card No. ______________________ Nationality________________
11. Mark of Identification ___________________________________________________
12. The prescribed Fee of Rs. _____________________________ has been remitted by
Bank Draft No. __________________________________ Dated: _______________
Or Cash Receipt No. ______________________________ Dated: _______________
Signature of Applicant
Phone No. _______________
English ____________________________
Urdu ______________________________
Dated: _____________________
Following documents must be submitted/attached with the application form:
1.
2.
3.
4.
5.
6.
7.
8.
9.
4 photographs attested by Dean/Chairman/Professor of the Faculty concerned.
2 Photostat copies of Degree attested by Dean/Chairman/Professor or the Faculty
concerned.
2 specimen Signature duly attested by Dean/Chairman/Professor or the Faculty
concerned.
2 Photostat copies of National Identity Card attested by Dean/Chairman/Professor or
the Faculty concerned.
2 Photostat copies of I, II, IIIrd, IVth and final year result Cards attested by
Dean/Chairman/Professor or the Faculty concerned.
Registration Fee Rs. 1000/Fee for Degree verification for as prescribed/required by the University Concerned.
Character Certificate from any Professor or the Faculty.
An affidavit attested from Oath Commissioner/Notary Public/Grade 18 Officer on
Non Judicial paper of Rs.20/- indicating specimen overleaf.
10. Attested Photo copies of Matric & FSc certificate.
11. An NOC from Provincial Council incase of other province.
NOTE:
(i)
Fee for Certificate of Registration of Pharmacist Rs. 1000/(ii)
Fee for Duplicate Certificate of Registration .. Rs. 1000/(iii) Renewal Fee Rs. 1000/-
AFFIDANIT
I,
_______________________________________________S/o___________________________________________
Cast _____________________________________Resident of ____________________________________________
Tehsil ________________________________District _________________________________do hereby Solemnly
affirm and declare as under:-
1. I passed Pharm - D/M. Pharmacy M. Phill. Pharmacy Examination in the Year _____________________________
Roll No. _________________ from the university _______________________________________________________
2. That the University ____________________ issued my B. Pharmacy / M.Pharmacy /M.Phill Pharmacy
Degree No. __________________ Dated ________________________ Which is genuine one.
3. That my National Identify card No.--------------------is genuine one
4. That I have never been granted registration certificate by any of the provincial
5. Pharmacy council in Pakistan, Neither I have applied for the same elsewhere.
6. That I have never been convicted by any court of law for an offence involving moral Turpitude.
7. That I have never been declared unsound by any court of law.
That as stated above are true to the best of my knowledge and belief.
VERIFICATION
DEPONENT
Verified on oath this _______________________
Day of _________________ at _________________
That the contents of this affidavit are true to the best of my
Knowledge and belief and nothing have been concealed.
DEPONENT
