_________________________________ _________________________________
Intern's Signature Intern's Signature
Lily C. Canuto, RPh Lily C. Canuto, RPh
Name & Signature of Pharmacist-in-Charge Name & Signature of Pharmacist-in-Charge
Prof. Tax No. (PTR) : 1337424 Noted by: Prof. Tax No. (PTR) : 1337424 Noted by:
Date Issued: 01/07/2013 Date Issued: 01/07/2013
Reg. No. (License): 0059736 Reg. No. (License): 0059736
Date Issued: 11/02/2011 Maam Adeltrudes B. Caburian, RPh, PhD Pharm Date Issued: 11/02/2011 Maam Adeltrudes B. Caburian, RPh, PhD Pharm
Date of Expiry : 03/09/2014 Internship Coordinator's Name & Signature Date of Expiry : 03/09/2014 Internship Coordinator's Name & Signature