11/25/29, 6:59 PM
Telangana State Pharmacy Council
RUE ee Ca ata
Oficial Website of Pharmacy Council
Present Work/Studying
Address
1. Attendance and Online Fee payment
Status of Re Renewal
Reference 14 s95WE1252511 Date Of Registration
Transaction Id FION7DVxMIFD Date Of Renewal
Exist Registration No 92016, From State
Name POTHULA RAIYA LAKSHMT DEVI Father Name
Date of Birth 12-Maye1990 Gender
Birth Piace NANDYALA Blood Group
Nationality 1NOTAN Date OF Application
category 8 Pharmacy Purpose
Email pray.bpharm@amal.com Mobile
Slot booked date 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,
8 Pharmacy
INTUA,
Nov-2012
HsN0:27-64/2/2, RAMBALRAM
NAGAR, NEREDMET, RAMA
KRISHNA PURAM POST
WORKING AS DR PHARMACY LINGODIGUDA KHARMANGHAT SAROORNAGAR RANGAREDDY
FOR OFFICE USE
Cencidate tended / Nt Attended Fee pai is
Verification Adequate / Inadequate verted oy
2. Original RP Certificate and Pass Book —_Surendorot Surender Vesa by
3. All Original Certificates Produced | Hot Produced Vered by
4. Original RP Certificate/Passbook Dispatches. Veied by
Found Genune/ Not Genuine
5.NOC Verification Module (of Candidate): Reference No Veied by
ate
2 Assatant Registrar
hntps:ifpharmacycouncl:elangana.govinipharmacyMeupharmacst
1811/25/29, 6:59 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 ( )
hntps:ifpharmacycouncl:elangana.govinvpharmacyMeupharmacst
2811/25/29, 6:59 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
hntps:ifpharmacycouncl:elangana.govinvparmacyMeupharmacst
som