Resolution Letter

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Close Corporation / Company / Partnership / Trust /Sole proprietor or sole trader Name:

_______________________________________________________________________
Registration Number:_______________________________________________________

RESOLUTION OF THE DIRECTORS OF THE COMPANY etc

RESOLVED that ___________________________________________, in his/her capacity as


______________________________________________, is authorised to make applications on

behalf of the Close Corporation / Company / Partnership / Trust /Sole proprietor or sole
trader for: new pharmacy licences; the change of ownership of existing pharmacy licences of a
third party; the change of trading title of pharmacies; the relocation of pharmacy licences to
different premises, change of owners name (which is not necessarily a change of ownership),
change of address (without relocation) and/or the recording of these licences online, as/when
issued by the Department of Health. The nominated person will also have access to webpage
for the pharmacy.

Signature(s) for Close Corporation / Company / Partnership / Trust/ Sole proprietor or sole
trader
(in the case where members exceed two, a maximum of three must sign this resolution letter)

1. ______________________________ Date: ____________________________

2. ______________________________ Date: ____________________________

3. ______________________________ Date: ____________________________

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