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Roll No_

PUNJAB PHARMACY COUNCIL, LAHORE.

(Established under Pharmacy Act, 1967)
ADMISSION FORM FOR
EXAMINATION OF PHARMACY ASSISTANT (REGISTRAR-B)
YEAR OF EXAMINATION_

Attested
Photograph to
be pasted here
by the applicant

THE REGISTRAR
PUNJAB PHARMACY COUNCIL
LAHORE
Sir,
I request for the permission to appear in the examination of the Punjab pharmacy council as provided
under section 29 of the pharmacy act 1976.i submit below the necessary particulars:1. Full Name:
2. Fathers Name:
3. Date of Birth:

4. Religion:

5. Caste:

6. Must attach the following:

I) Matric certificate II) Apprenticeship certificate under pharmacy act 1976
III) Dispenser certificate of Punjab medical faculty, Enrollment No.
Iv) Registrar -C Enrollment No.
(Attach attested copies of all certificate)
7. Permanent Address:
8. Postal Address:
9. Mark of identification:

Phone No:

10. N.B.P pay order No. /Bank draft no.

Dated:

11. National identity card No:

12. Matric certificate Roll No:

13. E-Mail- ---------------------------------Signature (English)

Signature (Urdu)

Appear in
Under Roll No.

(FOR COMPARTMENT EXEMPTED CANDIDATES ONLY)

Examination held in the month
_______ year ____________
and is eligible to re-appear in the subject of
in the next one / two chance according to result card.

Dated the
FOR OFFICE USE ONLY
Admission from has been received. Enrollment certificate, Apprenticeship or Dispenser
certificate and other required documents have been checked admission
Fee has also been received. May be admitted please.
Prepare by (Exam. Clerk)
checked by (Assistant)
Cash Receipt No.

Accountant

The Examination Fee is RS.4000/-and if not paid on due date, after the expiry of due date double fee
amounting Rs.8000/-has to be remitted.
Four attested passport size photograph, photocopies of National identity Card, Enrollment certificate,
Metric, Dispenser, (if any), character and Apprenticeship certificate shall have to be attached.
(II) Incomplete form shall not be accepted.
TO BE FILLED BY CANDIDATE
Roll No.

FOR ORIGINAL CERTIFICATE

Roll No.

Name:

Name:

Fathers Name:

Fathers Name:

Address:

Address:

FOR RESULT INTIMATION

Roll No.

FOR ROLL No. SLIP

Roll No.

Name:

Name:

Fathers Name:

Fathers Name:

Address:

Address:

REGISTERED
ROLL No.
Candidate will be admitted in the Examination Hall production and delivery of this Roll Number slip.
Please bring your National identity card during theory and practical Examination.

PUNJAB PHARMACY COUNCIL, LAHORE

Admit Mr./Miss./Mrs.

S/o, D/o, W/o:

In the Examination being held on

At center

at the

Attested
Photograph to be
pasted here by the

NOTE:Mobil Phone not allowed in the Examination hall.

applicant

Signature of candidate

REGISTRAR
PUNJAB PHARMACY COUNCIL

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Following documents must be submitted/attached with the application form:
1. Apprenticeship certificate as required under Pharmacy Act 1967, issued by a Pharmacist
regular employ of Government and notified by the Government of Punjab. (Not for
dispenser). Dispenser shall submit 4 attested photocopies of Dispenser Certificates.
2. Attested ID Card/Domicile.
3. Attested Photocopy of Matric Certificate.

4 Nos.

4. Recent Character Certificate issued by Class-1 Officer (Original)

5. Attested Affidavit on Non-Judicial Paper of Rs. 20/- as prescribed

6. Attested Photographs

6 Nos.

7. Attested 3 specimen signature

8. Bank Draft for Examination Fee in the name of Secretary, Punjab Pharmacy Council, Rs. 4000/-.
9. Challan Form of Verification fee deposited in the bank of for the Intermediate Board concerned
10. Challan of fee verification for Punjab Medical Faculty Rs. 1000/- (if dispenser)
11. Attach all documents in a hard and fine file cover

Note: -

The above mentioned documents are not needed for supplementary exam,
only pay admission fee Rs.4000/-

APPRENTICESHIP CERTIFICATE
Under Pharmacy Act, 1967

It is to certify that Mr./Miss.

S/D/o
Resident of

has taken as apprentice by the undersigned with effect from

for a period of

two years as required under Pharmacy Act, 1967.

He is working at M/s
License No.

Sr. No.
Date:
Signatures

Name
Address
Reg. Cert. No.
Renewal Valid Upto