PUNJAB PHARMACY COUNCIL, LAHORE

(Established under Pharmacy Act , 1 967 )

APPLICATION FORM FOR REGISTRATION AS PHAR MACY ASSISTANT

(REGISTRATION IN REGISTER “B”)

Attested
Photograph to
be Pasted by
the Applicant
To size 4½ x 5½ cm
THE SECRETARY,
PUNJAB PHARMACY COUNCIL,
LAHORE.

SUBJECT: - REGISTRATION AS PHARMACY ASSISTANT

Sir,
I hereby submit that I appeared in the examination of Pharmacy Assistant conducted by Punjab
Pharmacy Council under section 29 of Pharmacy Act, 1967 amended in 1973 held in _______________
under Roll No. ________________ and was declare successful. I therefore, apply for registration
pharmacy assistant in register ‘’B’’ of Punjab Pharmacy Council.
My particulars are as follows:-
1. Name (Block Letter): _______________________________________________________
2. Father’s Name: ______________________________________________________________
3. Permanent Address: __________________________________________________________
__________________________________________________________________________
4. Professional Address: __________________________________________________________
__________________________________________________________________________
5. Enrollment Certificate No. ____________________________________________________
__________________________________________________________________________
6. Mark of Identification: _______________________________________________________
The prescribed fee of Rs. 2000 has been remitted by Demand Draft / Cash/
No _____________, Dated___________________
Yours Obediently
Mobile No. _____________________ Signature: _________________
Dated: ___________________

Instruction:
Following document to be submitted along with the application form:
1. Photostat copy of Enrollment Certificate C (if any)
2. 3 Attested photographs (size 4½ x 5½)
3. Photostat copy of Result Card
4. Specimen Signatures. 3
5. Affidavit as per specimen given overleaf on Non-Judicial paper of Rs. 20 duly attested by Oath
Commissioner / Gazetted Officer.
6. Fee of Rs. 2,000 will be accepted by Cash/Demand Draft