My Ambition in Life
10. GCPP-142-FD-50Pads. X100 Sheets(C6)-30-10-2001
DECLARATION FORM
(To be filled and retured to the Assistant Commissioner, Food and Drugs Administration, Pondicherry) N.B. No Column should be left blank or with a dash. If you have not particulars to be furnished for any column, NIL/Does not arise should be entered.
1. Name and Complete address of the firm : LAKSHMI MEDICAL Old No. 84, New No. 87, Villianur Road, Sithananda Nagar, Puducherry 605 005. 2. Name and residential address of all partners / Manager : 3. Applicants experience if any in Drugs Trade : 4. Applicants Predent Occupation : 5. Is the application for fresh or renewal : RENEWAL 6. Was there any change in Proprietorship Partnership of the concern since the issue of previous licences and if so from hat date (A true copy of the sale deed should be enclosed) : 7. Was there any change in premises of the conern : since the issue of previous licence if so from hat date 8. Particulars of licences held by the applicant in respect of the present application is amde 1. D&C Act Form No. Licence No. Date of Issue 20 /20A 08012249 20.06.2008 20 /21A 08092250 2. Poison Act Form A 9. Addresses of other premises where the drugs are stocked or sold or office is maintained by the applicant their drugs licence Nos. form of licence pertaining to the above should be stated : NIL 10. Mention the categories of the form of company : (a) Restaurant (b) Provision Store (c) Betal Nut Shop (d) General Merchant (e) Holesale Dealer (f) Chemists & Druggist (g) Pharmacy (h) Importers (i) Distributing Agency 11. Is there separate cup-board or drawer reserved solely for the storage of Posion :
DECLARATION FORM
(To be filled and retured to the Assistant Commissioner, Food and Drugs Administration, Pondicherry) N.B. No Column should be left blank or with a dash. If you have not particulars to be furnished for any column, NIL/Does not arise should be entered.
1. Name and Complete address of the firm : LAKSHMI MEDICAL Old No. 84, New No. 87, Villianur Road, Sithananda Nagar, Puducherry 605 005. 2. Name and residential address of all partners / Manager : 3. Applicants experience if any in Drugs Trade : 4. Applicants Predent Occupation : 5. Is the application for fresh or renewal : RENEWAL 6. Was there any change in Proprietorship Partnership of the concern since the issue of previous licences and if so from hat date (A true copy of the sale deed should be enclosed) : 7. Was there any change in premises of the conern : since the issue of previous licence if so from hat date 8. Particulars of licences held by the applicant in respect of the present application is amde 1. D&C Act Form No. Licence No. Date of Issue 20 /20A 08012249 20.06.2008 20 /21A 08092250 2. Poison Act Form A 9. Addresses of other premises where the drugs are stocked or sold or office is maintained by the applicant their drugs licence Nos. form of licence pertaining to the above should be stated : NIL 10. Mention the categories of the form of company : (a) Restaurant (b) Provision Store (c) Betal Nut Shop (d) General Merchant (e) Holesale Dealer (f) Chemists & Druggist (g) Pharmacy (h) Importers (i) Distributing Agency 11. Is there separate cup-board or drawer reserved solely for the storage of Posion :