'Ten Rupee S: Deel A RLT

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'TEN

RUPEE
S

IN RT OF THE EXECUTIVE IVIAPHR/11 3.99

TANUI-CHOUDV,Ri JAGATPUR. CUTTACK


D e e l a r L t

t, aL aged about 2 , years..Do- Haramohan Biswal. residew


At- Tantitra, Remora. P.s. TanD. Dist- Cuttack. Ochsha do hereby solemnis
affirm and state as follows .
I. That I am a Registered Pharmacist having Registration (Certif .- leak, No-28836
(OPC, l S 31ta) & 32 121 dated 28 11.2015 valid upto December 2024 2 That 1
was workingas a Pharmacist in charge of Sale and Purchase of dnigs in the
premises of M's lateswan Ausodhalaya situated at- Ramagarh. N Tangi. Dist-
Cuttack from dt 25 06.2020 to dt 21 12..2022.
3. That now I want to work as Pharmacist in the premises of" tv1. -
Medicine Store situated at- Nakhara. P.o- Nakhara. Ps - Choudwar. Dist- Cuttack in
the City of Cuttack on whole time basis to supervise the sale of dotty T. q a
period of 5 years without an, discontinuation w e f dt 21 12 2022
• That this affida, a is to he filed before the Drugs Contoller. Odisha.
(Licensing Authority' through the Drugs Inspector. Odisha. Cutiack-VII Range.
Cuttack for acceptance my consent as Pharmacist
5 That the facts stated above are all true to the best of my knowledge and beleit.

Deponent Certified that the above named


deponatt is Mondial by S.R.Par)a
ads. Corral; nostOtr,Z personn4, present
before me on 21st day of December
2022 at _04, O,, am pm and stionnl, affinn and gates before me that die 'acts gated above am nue tofitie bawl his krmiaige
6 beied• J a g a t p u r J w
Dt- 21 12 .2022 Executive

2023-5-28

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