eer No. 03)0- Date.. That, | am not attached anywhere else as a Regd. Pharmacist or in any other capacity at present and was previously engaged “M/S- Dey’s Medical” Vill & P.O-Changrabandha, P.S- Mekliganj, Dist-Cooch Behar from 05/08/2011 to 31/03/2019 and released from this Firm from & on 01/04/2019. | further state that | have got no objection if the reverse side of my original Registration Certificate is stamped by the authority while granting licence(s). That in the event of my above statements are found false, | shall be liable to all legal consequences so far as my ethical standards as a Registered Pharmacist is concerned. That | know that furnishing false information to a public servant is a criminal offence of the Indian Penal Code (IPC) and | may be prosecuted by the appropriate authority before and even after issuance of license for such act. Shorla Brata Dar DEPONENT(S) Verification:- That all the statements made above are true and correct to the best of my knowledge and belief. Shanta Brota Dos. DEPONENT(S) Identified by me and signed in my presence — eos ADVOCATE PRADIP BISWAS SOLEMNLY AFRIRMED BEFORE ME see ‘Pharbabrala..do9 e ADVOCATE A ANJ, THIS SYA... f pay of Mond: 2:02. AMIPM a oa fon 9 Executive Magisir Mekfiganj