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Form - 'G'
FORM OF APPLICATION FOR 1
st
REGISTRATION AS A PHARMACIST
UNDER SECTION 32(2) OF THE PHARMACY ACT, 1948
Applicant’s Name (As per registration certificate)
*
Date of Birth
*
MM slash DD slash YYYY
Father’s/Husband’s Name
*
Full (Permanent) Residential Address
*
Full Temporary/Professional Work Address
*
Nationality
*
Religion
*
Telephone/Mobile No
*
E-Mail Address
*
Domicile if the Indian domicile has been acquired recently, Sate when and where it was acquired
Aadhar number
*
If you are not Indian National, does country where you acquired by qualification permit persons of Indian origin possessing qualification of that country to enter and practice the profession of Pharmacy there, if so, quote section or rule under which this is permitted in that country
Qualification Description for which registration is required
High School
Year
Name of Examining Body which awarded
Name of College/Institution
Commenced on Date/Year
Ended on dated/Year
Intermediate
Year
Name of Examining Body which awarded
Name of College/Institution
Commenced on Date/Year
Ended on dated/Year
D.Pharm
Year
Name of Examining Body which awarded
Name of College/Institution
Commenced on Date/Year
Ended on dated/Year
B.Pharm
Year
Name of Examining Body which awarded
Name of College/Institution
Commenced on Date/Year
Ended on dated/Year
M.Pharm
Year
Name of Examining Body which awarded
Name of College/Institution
Commenced on Date/Year
Ended on dated/Year
Pharm D
Year
Name of Examining Body which awarded
Name of College/Institution
Commenced on Date/Year
Ended on dated/Year
Employment Details
Date from which practicing in Uttarakhand
MM slash DD slash YYYY
Whether employed in or attached to Government or State aided institution, if so State is name address and the date from which employed
Basic Qualification (Educational) before joining the training of Pharmacy
Documents need to be upload
(max size-1MB file types-pdf, jpg, docx)
Domicile (if available)
Accepted file types: jpg, pdf, docx, Max. file size: 1 MB.
Aadhar Card (mandatory)
*
Accepted file types: jpg, pdf, docx, Max. file size: 1 MB.
High school marksheet & passing certificate
*
Accepted file types: jpg, pdf, docx, Max. file size: 1 MB.
Intermediate marksheet & passing certificate
*
Accepted file types: jpg, pdf, docx, Max. file size: 1 MB.
Diploma / Degree (all year marksheet)
*
Accepted file types: jpg, pdf, docx, Max. file size: 1 MB.
Provisional diploma / Degree or permanent diploma & degree
*
Accepted file types: jpg, pdf, docx, Max. file size: 1 MB.
Photograph
*
Accepted file types: jpg, pdf, docx, Max. file size: 1 MB.
Specimen signature
*
Accepted file types: jpg, pdf, docx, Max. file size: 1 MB.
Apprentice training certificate (500 hr. training, only for D Pharm applicant)
Accepted file types: jpg, pdf, docx, Max. file size: 1 MB.
Affidavit
*
Accepted file types: jpg, pdf, docx, Max. file size: 1 MB.
Fee receipt (UPI/UTR/Transaction/Account No)
*
Accepted file types: jpg, pdf, docx, Max. file size: 1 MB.
One year Training Certificate (only for D Pharm applicant)
Accepted file types: jpg, pdf, docx, Max. file size: 1 MB.
Note: At the time of verification of original documents in the council office, also submit the original copy of your provisional certificate, oath sheet and training certificate of 500 hours along with A4 size envelope and 9x4 size envelope with pasted speed post stamp (current charges) and 1 Passport size photo.
(नोट: काउन्सिल कार्यालय में मूल दस्तावेजों के सत्यापन के समय अपने प्रोविजनल प्रमाण पत्र, शपथ पत्र एवं 500 घंटे के प्रशिक्षण प्रमाण पत्र की मूल प्रति के साथ A4 साइज एवं 9x4 साइज के स्पीड पोस्ट (मूल्य के बराबर) टिकट लगे हुए लिफाफे व 1 पासपोर्ट साइज़ फोटो भी जमा करायें ।)
Note: Please take a prior appointment with the Council before visiting the office to submit all documents.
(नोट: काउन्सिल से अनुमति लेने के पश्चात् ही मूल दस्तावेजों के सत्यापन के लिए काउन्सिल में उपस्थित हों ।)
Registration fee Rs. 500 and Pharm D Registration fee Rs. 1000
Note: Along with the registration fee Rs. 500, submit Rs 100 for the form fee.
(कृपया रजिस्ट्रेशन फीस 500 के साथ 100 रूपये फॉर्म फीस भी जमा करें !)
For online payment -
Account Holder - Uttarakhand Pharmacy Council
Bank - State Bank of India
A/c No. - 36821630863
IFSC - SBIN007893
*
I hereby confirm that the above information is correct. I undertake to provide the originals of any of the documents mentioned above should they be required by UKPC. I accept that UKPC Rules and Regulations stipulated here may be subject to change.
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