Ashadip PSC

APPLICATION TYPE *

New License Offline License

TYPE OF FIRM *

Wholesale Retail

NAME OF FIRM *

NATURE OF FIRM *

FIRM FULL ADDRESS WITH PIN NO *

MOBILE NO *

TELEPHONE NO

E-MAIL ID

QUALIFICATION OF THE PERSON RESPONSIBLE FOR OPERATION if Granted

CATEGORIES OF DRUGS TO BE SOLD *

LOCATION OR DIRECTION
(Rail / Bus Stoppage Route )

ACTUAL FLOOR SPACE AREA *
(in sqft)

HIGHT FROM FLOOR TO CEILING *
(in Ft.)

TRADE LICENCE *

Applied for License Available

Name *
Address *
Email *
Phone No *

APPLICANT FULL NAME *
GENDER *	Male Female Trans Gender
DATE OF BIRTH * (dd/mm/yyyy)
FULL ADDRESS WITH PIN NO *
AADHAAR NO
MOBILE NO *
E-MAIL ID

STATEMENT ON CONSTUCTION OF THE PREMISES
NATURE OF CEILING *
TRADE LICENCE OR TAX RECEIPT FROM THE LOCAL GOVT./PANCHAYAT HAS BEEN ENCLOSED ? *	Yes No
PREMISES / BUILDING TYPE *
WORKING HOUR *
TOTAL WORKING DAYS * ( In a week )
WEEKLY CLOSING DAY *

NAME *
DATE OF BIRTH * (dd/mm/yyyy)
QUALIFICATION *
REGISTRATION NO *
EXPERIENCE * ( in years )
PHARMACIST IDENTITY PROOF * Any One (Votar Card / Pan Card / Aadhaar Card / Passport / Driving Licence)
APPOINMENT LETTER
JOINING LETTER
EDUCATIONAL CERTIFICATE
EXPERIENCE CERTIFICATE

WONER 1 NAME *
WONER 1 PHOTO *
WONER 1 SIGNATURE *
WONER 2 NAME
WONER 2 PHOTO
WONER 2 SIGNATURE
WONER 3 NAME
WONER 3 PHOTO
WONER 3 SIGNATURE
WONER 4 NAME
WONER 4 PHOTO
WONER 4 SIGNATURE

Miscellaneous License/Registration

Form - Drug Licence

Total Expenses : Rs 11800/-

:: Contact Person Details ::

APPLICANT DETAILS

FIRM DETAILS

ADDITIONAL INFORMATION OF FIRM

PHARMACIST DETAILS

WONER DETAILS

( In case of Partnership Business you can upload a maximum 4 woner signature and image )

DOCUMENTS

FEES DETAILS

Total Expenses Rs ....../- Including All Govt Charges

SPONSORED INFORMATION AND FINAL SUBMISSION

Our Team

Kiran Bala Dey

Nisha Sarki

Gopal Bera

Mousumi Pal

Chhanda Barik

Rabina Kumari Sharma

ANINDITA ROY

DEBIKA SUBBA

Jharna Mallick

ARPITA CHAKRABORTY BANERJEE

Contact Info

Visit Us

Mail Us

Call Us

Feel free to write your query

ASHADIP PSC

POWER OF ATTORNEY (if any) IN NON-JUSICIAL STAMP PAPER AS PER PROFORMA
TRADE LICENCE / TRADE ENLISMENT CERTIFICATE, MENTIONING NATURE OF TRADE (retail/wholesale) & SYSTEM OF MEDICINE (allopathy/homoeopathy) *
POSSESSION DOCUMENT OF THE PREMISES * ( Current House Tax Receipt/Consolidated rate bill/Registered deed of conveyance/consent letter from the owner / NOC in the form of affidavit before first class Judisial Magistrate rent bill singed by owner or authorised signatory/as the case relates to p
IN CASE OF PARTNERSHIP FIRM REGISTERED PARTNERSHIP DEED ALONG WITH FIRM REGISTRATION RECEIPT , IN CASE OF LIMITED OR PVT. LTD. COMPANY OR LLP - COPIES OF MEMORANDUM AND ARTICLES OF ASSOCIATION
COPY OF RESOLUTION OF THE BOARD MEETING WITH ALONG LIST OF PRESENT BOARD OF DIRECTORS WITH RESPECT TO LIMITED OR PVT. LTD. COMPANIES
SKETCH MAP OF PROPOSED PREMISES WITH LOCATION AND SURROUNDINGS (CAD MODE) *
PHARMACIST / CPI RECORD FROM , REGISTRATION CERTIFICATE AND RENEWAL CERTIFICATE OF PHARMASIST *
AFFIDAVIT OF PHARMASIST OR CPI SWORN *
EXPRIENCE CERTIFICATE OF CPI (COMPETENT PERSON INCHARGE) ( as per rule )
AFFIDAVIT OF APPLICANT (PROPRIETORS/PARTNERS/DIRECTORS) SWORN *
ANY OTHER DOCUMENTS