11725109, 7:24 PM Oficial Website of Pharmacy Council Telangana State Pharmacy Council RUE ee Ca ata Reference 14 Transaction Id Exist Registration No Present Work/Studying Address Verification 3. All Original Certificates 1. Attendance and Online Fee payment 2, Original R.P Certificate and Pass Book 4. Original RP Certifieate/Passbook 5. NOC Verification Module (of Candidate): Status of Re Renewal s95WE1252511 Date Of Registration FION7DVxMIFD Date Of Renewal 92016 From State Name POTHULA RAIYA LAKSHMT DEVI Father Name Date of Birth 12-Maye1990 Gender Birth Piace NANDYALA Blood Group Nationality 1NOTAN ate of Application category 8 Pharmacy Purpose Email pray.bpharm@amal.com Mobile Slot booked date 29-Nov-2023, Time stot ACADEMIC INFORMATION Hall Ticket ostc1n0029 Category coll Name sntcek Board/University Academic From Sep-2008 ‘Academic To PHARMACIST ADDRESS H:NO:27-64/2/2, RAMBALRAM Residential Address NAGAR, NEREDMCT, RAMA Present Address KRISHNA PURAM POST working ReGileltns 18-0ct-2014 21-Dec-2023 ANDHRA PRADESH POTHULA SANJEEVA RAYUDU Female on 25-Nov-2023 e-Renewal 9603070623, 1AM-1PM 8 Pharmacy INTUA, Nov-2012 HsN0:27-64/2/2, RAMBALRAM NAGAR, NEREDMET, RAMA KRISHNA PURAM POST WORKING AS PHARMACIST DR PHARMACY LINGOJIGUDA KHARMANGHAT SAROORNAGAR RANGAREDDY FOR OFFICE USE Cencidate tended / Nt Attended Fee pai is Adequate / Inadequate verted oy Surrondr Not Surender Vesa by Produced | Hot Produced Vered by Dispatches. Veied by Found Genune/ Not Genuine Reference No ered by ate 2 Asstatant Registrar -ntps:ifpharmacycounel:elangana.govinvpharmacyMieupharmacst?eterenceld=535WE1252311random_not=FION7OVXMIFD 1811125109, 7:24 PM Oficial Website of Pharmacy Council FormG bate (See Rule 77) Form of Application for Renewal of Registration To [AFFIK PASSPORT ‘The Registra SIZE PHOTOGRAPH Telangana State Pharmacy Coun, win WHITE Vengalra Nagar, Hyderabe wacicnatiin si I request that my name be registered asa pharmacist under the Pharmacy Ret, 1948 and that I may be furnished with 3 certificate of registration. Necessary particulars are given on the online application "enclose herewith for your perusal and return the certiestes in original and their copies tor record Ia your office, I hereby declare that I have read carefully and understood the instructions on the wabsite And that all entries on the online application are true to the best of my knowledge and belie. agree that | will folow the rules of the Pharmacy Council which may be lsd down for the guidance of the registered pharmacists from time to tine. Youre aitnflly, (Signatures of Applicant) Enclosed Checklist for Renewal of Registration who are due for Renewal validate date i December 2019 & above inal +1 xerox copy (Original should be surrendered at the time of ar 1. Renewal Pass Book Or submission) 2. Original Registered Pharmacist Certificate Original +1 Xerox Copy of front & Back (Orginal Should be Surrendeted atthe time of submission 3. Acdlitonal Quaitieation Certificate (8 Pharm/ta Pharm) # registered in A P.Pharmacy Council (Criginal Should be surrendered atthe time of submssion) Original +1 Xerox Copy. Matriculation, 5 5.C or Equivalent Certificate Original + 1 Xerox Copy, Intermediate Cerificate Original +1 Xerox Copy. Diploma/Dearee/M Pharm/Pharm 0 Certificate Original + 1 Xerox Copy Bonafide Certificate or Study Certificate Original + 1 Xerox Copy It Employed in any Feld (Orug License/College/Industry ID ete) + 1 Xerox Copy Residential proof of any one (Election I0/ Aadhar Card/Bank Account of Nationalized Bank PPasspor/Driving License: Original + 1 Xerox copy. 10, Recent Passport Size Photograph not less than 2 weeks with White Background (Without Mask Scarf 11, 1Big Size Cover 14% 10° afin with Rs 40/ Proof 12, 1Big Size envelope affixed with As. 40/- Postal Stamps, sta Stamps. (Sel addressed asin Residential ‘Note: 1f applying for M.Pharmacy upload the M.Phermacy Study Certfcte and M.Phormacy ‘Degree/Convocaton Certficate (Originals +1 Photocopy). 2. Online Confirmation or Demend Drft or Chllan Form of MPharm Certificate from respective University Ui applicable) taken within a week before sit dete (Signature of Applicant) (Office use only) Ail Original Certitiates Veriton ( ) https:iIpharmacycounel:elangana.govinvpharmacyMieupharmacst?eterenced=535WE1252311random_not=FION7OVXMIFD 2811725109, 7:24 PM (Ofciat Website of Pharmacy Council Non-refundable deposit form (To be submitted along with application for Renewal of Registration of D Pharm/B Pharm/Pharm D) ‘The Registrar, ‘Telangana State Pharmacy Council, Vengalrao Nagar, Hyderabad, Sub: Payment of Non-refundable deposit for future renewal of my registration Ref: My Application for registration submitted today. | pay an amount of Rs.300/- (Rupees Three Hundred only) and request you to please ‘reat this amount as Non-refundable deposit for Renewal fees in order to avoid difficulties arising out of my inadvertent failure to pay the renewal fees every (5) years, in time, Lurther request you that necessary part of the Annual Interest occurred on my deposit be adjusted towards my renewal fees every (5) years and remaining amount if any be utilized by the Council If due to some reason this amount becomes inadequate to cover my renewal fees, | hall be to glad to remit such additional amount as you may decide, In the event of cancellation of my registration or abolishing of NRD scheme, this deposit may be accepted as my donation to the Council | assure you that | will inform you my residential or professional address if there is any change. ‘Thanking you sir. Yours faithful Signature & Date TELANGANA STATE PHARMACY COUNCIL Referenced 535WE1252311 ‘Transaction Id FloN7ovx0tFD Name POTHULA RAIVA LAKSHM DEVE Father Nome POTHULA SANIEEVA RAYUDU category Pharm Purpose een Signature hnttps:ifpharmacycounel:elangana.govinvpharmacyMieupharmacst?reterenced=535WE12523118random_not=FION7OVXMIFD som