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Drug License Declaration Form

This document is a declaration form for obtaining or renewing a drugs license. It requests information such as the name and address of the firm applying, the names and roles of directors/partners, and confirmation that the information provided is accurate. The applicant must notify any changes to the firm's name, partners, or their addresses. They also must indicate whether the license application is for an initial license, addition/change to an existing license, or license renewal.

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Hitesh Hanotia
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180 views1 page

Drug License Declaration Form

This document is a declaration form for obtaining or renewing a drugs license. It requests information such as the name and address of the firm applying, the names and roles of directors/partners, and confirmation that the information provided is accurate. The applicant must notify any changes to the firm's name, partners, or their addresses. They also must indicate whether the license application is for an initial license, addition/change to an existing license, or license renewal.

Uploaded by

Hitesh Hanotia
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

DECLARATION FORM

DRUGS LICENCE No.:

Name of Police Station:

Name of Firm :
Address of Firm :

Whether Prop/Partner/Ltd. or Pvt. Ltd. :


Firm Regn. No. :

Sno. Name of Director/


Partner/ Prop.

e-mail :

Residential Address

Signature

1.
2.
3.
4.
5.
Name of Mg. Director / Partner (responsible for conduct of day to day business of the firm) :.
Your occupation during last three years :

1. I will intimate in the event of any change in the name of the Firm/ Partners of the firm and
their addresses.
2. Certified that
a. the present application is for grant of licence(s) on account of (tick correct one):
Fresh licence(s) (for first time).
Licence(s) due to Addition or Change in (Constitution/Name/Premises).
Renewal of licence(s).
b. the information given in this declaration from is correct to the best of my knowledge and
belief of the undersigned and nothing material has been concealed there from.

Date :

Signature
Managing Director / Prop. / Partner.
e-mail ID.:
Mob No. :

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