ADDITIONAL INFORMATION TO BE SUPPLIED WITH THE APPLICATION

FOR MANUFACTURING OF DRUGS AYURVEDIC DRUGS, HOMEOPATHIC

DRUGS, SCHEDULES X DRUGS & COSMETICS.

Name of Applicants Proprietor or :

Directors, proprietors, etc. and full
Residential addresses of each
With telephone no. or residence .
And office & age.
List of Partners with age, Phone no.,
& full residential address is attached
separately.

1 What was the business carried out :

by the applicants within the last
three years?

2 Has the applicant ever engaged :

himself or on behalf of any other
person in manufacturing or selling
drugs any time prior? If so the
dates by given.

4 Whether the applicant Proprietor is a:

registered pharmacist?

5 Is other business is carried on by :

the applicant at present?

6 Was the applicant or any person at :

present employed by him on these
premises ever convicted and
sentenced under?

A Drugs & Cosmetics Act, 1940

B Dangerous Drugs Act, 1930

C Bombay Prohibition Act, 1919

D Vombay Drugs (Control) Act, 1952

E The Poisons Act, 1919

F The Pharmacy Act, 1948

 7 The applicant does/ does not manufacturers:
for sale drugs at any premises except at
the premises for which this applicant
is applied for
Or
This address of other premises are:
1.
2.
3.

8 What category of drugs are mfged. Or:

intended to be mfgd. By the firm?

9 Whether in the past, license/s of the :

firm was /were suspended or cancelled?

10 Hours of business and working days :

with holidays. In case of change in
the holiday, the same should be
intimated to the licensing authority.

11 Name of the trade or professional :

association of which applicant is a
member and the date of
commencement of membership.

I, certify that all the above information is true and understand that my application is liable
to be rejected summarily or the license is liable to be cancelled forthwith if the above
information is proved to be false in any particular.

Date: Signature of the applicant