Compr’ FORM (RULE 71 & 76) NAME OF STAFF Residen Address : Name of the Company : Engaged in Manufaeturing/Analysis : For Analysis Full / Part Time : Mention Days & Time : ‘Name of other company (In which he is employed ) University Past Experience : ENT TECHNICAL STARE ‘Year of Passing Subject%_ Total period of Experience after Graduation (10 BE FILLED IN BY SENIOR / INSPECTOR OF DRUGS ) 1. Where the copies of the Certificates and Testimonials are verified with the original and kept in the file as mentioned in column 6 & 8 2. Mention whether the Applicant has studied Chemistry as a principal subject during his Graduation. Signature of Senior / Inspector of Drugs& the Notary Public, ...cccecssees AFFIDAVIT son of Sri... and declares as follows... plete too) pharma: That the deponeat is the sole proprietoy’? Ms . ‘Situated at 1 neither the firm nor the Proprietor/ Directors/Partners/ ef the firm has never been victed under the Drugs & Cosmetic Act, 1940. ‘That the premises at . yysicul and legal possession of the firm. 2. That the firm has appointed Sri/Smi/Mr/Dr..... as Analytical / Manufacturing Chemist. Deponent .. that the contents of above affidavit are Verified on tl ‘ © and vorvect to the best of my knowledge and | belief and nothing in materials has been sealed there from Deponent Known and [dentified by me Advocate,Before the Notary Public residing at .. . and declare as follows - AFFIDAVIT aged about ...... years S/o / Dio Sri . . by occupation ... seccusesssnee do heveby solemnly affisms «by religion .. That the deponent has passed from . Inthe year ... 2 That the deponent has joined M/s ... situated at cinta yarenechneann sas with effect fFOM eee cece BS : Full time e/ Part | time ‘Analytical Chemist / Manufacturing Chemist for manufacturing Ayurvedic Drugs. 3 That the deponent is not employed any where else except with M/s 4 That the deponent shall inform the office of the Drugs Controller, ISM Drugs Control. West Bengal as and when he leave the present firm .. Verified on this veseeoe-» that the contents of my above affidavit are true and correct to the best of my knowledge and belief and nothing in materials has been concealed there from. Deponent Known and Identified by me Advocate.