Application for Re-registration by Transfer
To
The Registrar,
Latest
A.P.Pharmacy Council,
Passport Size
Chuttugunta, Guntur.
Colour Photo
Sir,
I am a registered pharmacist---------------------
in Pharmacy Council with Registration
No………………………………../…… Dated………………….. valid up to 31/12/…………………….
I am presently practicing Pharmacy/Working in M/s……………………………………………………..
as …………………………. . I request you to re-register my name by transfer to Andhra Pradesh
Pharmacy Council.
I am submitting Original R.P.Certificate/Pass-Book, Id-Card etc issued by said Pharmacy
Council.
I am also submitting the relevant documents and request to re-register me as
pharmacist under the Pharmacy Act, 1948.
I agree that I will follow the rules of the A.P Pharmacy Council which may be laid down
for the guidance of the registered pharmacists from time to time.
Date: / / Yours faithfully,
(Signature of
applicant) Address:
Encl: as per checklist
FOR OFFICE USE ONLY
Receipt No:
Correspondence to Other
APPC Regn. No
Date:
State Councils
Date:
Amount:
1.Sent Ref No:
Date:
Despatch:
By Post/ Person
RL/Sign:
2. Reply Ref No:
Ref No:
Date:
Date:
Specimen Signatures of the applicant (within boxes)
Particulars for 'application for Re-registration'
1.
Name of applicant with Surname
:
(as in Diploma/Degree Certificate in Block letters)
2
.
Father’s Name
:
3.
Date of Birth:
: Place of birth:
4.
Nationality
:
5.
Permanent Residential address
:
(as per proof of residence in Block letters)
Pincode:
6.
i. S.S.C:
year of passing
:
ii. Intermediate: year of passing
:
7.
i.
Education in Pharmacy
:
ii. Year of passing
:
iii. Period of course
: from
to
iv. College Name & Address
:
v. Name of University
:
8.
Name of the Institution where
Practical training is undertaken
:
9.
Mobile No:
: Email id:
10. Details of employment
i.
Designation
:
ii.
Institution Name
:
iii. Address
:
(Signature of applicant)
Paste here Rs.3
Court Fee Stamps
Non-refundable deposit form
(To be submitted along with application for Registration of D Pharm/B Pharm/Pharm D)
To
The Registrar,
Andhra Pradesh Pharmacy Council,
2
nd
Floor, Chuttugunta, Guntur.
Sub: Payment of Non-refundable deposit for future renewal of my registration.
Ref: My Application for registration submitted today.
I pay an amount of Rs.300/- (Rupees Three Hundred only) and request you to please
treat this amount as Non-refundable deposit for Renewal fees in order to avoid difficulties
arising out of my inadvertent failure to pay the renewal fees every (5) years, in time.
I further request you that necessary part of the Annual interest occurred on my deposit
be adjusted towards my renewal fees every (5) years and remaining amount if any be utilized
by the Council.
If due to some reason this amount becomes inadequate to cover my renewal fees, I shall
be to glad to remit such additional amount as you may decide.
In the event of cancellation of my registration or abolishing of NRD scheme, this deposit
may be accepted as my donation to the Council.
I assure you that I will inform you my residential or professional address if there is any
change.
Thanking you sir.
Yours faithfully,
Signature & Date
