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    Application Renewal Restore (30138) PDF

    Uploaded by

    Rashmi Paniya
    Anurag Ranga is applying for restoration and renewal of his pharmacy registration in Rajasthan, which had lapsed due to failure to pay renewal fees on time. His registration number is 30138 and is currently listed as expired. He requests renewal of his registration from January 1, 2017 to December 31, 2019 and provides his updated contact and address details, as well as proof of online payment of the 800 rupee fee. He affirms that the information provided is true and correct.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Application Renewal Restore (30138) PDF

    Uploaded by

    Rashmi Paniya
    297 views1 page
    Anurag Ranga is applying for restoration and renewal of his pharmacy registration in Rajasthan, which had lapsed due to failure to pay renewal fees on time. His registration number is 30138 and is currently listed as expired. He requests renewal of his registration from January 1, 2017 to December 31, 2019 and provides his updated contact and address details, as well as proof of online payment of the 800 rupee fee. He affirms that the information provided is true and correct.

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    Application-Renewal-Restore(30138).pdf

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    Anurag Ranga is applying for restoration and renewal of his pharmacy registration in Rajasthan, which had lapsed due to failure to pay renewal fees on time. His registration number is 30138 and is currently listed as expired. He requests renewal of his registration from January 1, 2017 to December 31, 2019 and provides his updated contact and address details, as well as proof of online payment of the 800 rupee fee. He affirms that the information provided is true and correct.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    297 views1 page

    Application Renewal Restore (30138) PDF

    Uploaded by

    Rashmi Paniya
    Anurag Ranga is applying for restoration and renewal of his pharmacy registration in Rajasthan, which had lapsed due to failure to pay renewal fees on time. His registration number is 30138 and is currently listed as expired. He requests renewal of his registration from January 1, 2017 to December 31, 2019 and provides his updated contact and address details, as well as proof of online payment of the 800 rupee fee. He affirms that the information provided is true and correct.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Application for Restoration and Renewal of Registration

    18/09/2017
    To
    The Registrar
    Rajasthan Pharmacy Council
    Government Dispensary Campus
    Sardar Patel Marg, Jaipur – 302001
    Sir
    I, ANURAG RANGA s/o Shri N.B.RANGA, wish to inform you that my name was removed from the
    Register of Pharmacists of Rajasthan State as I failed to pay renewal fee in time.
    At present, my renewal is upto year 31/12/2016 and my name is entered as eligible person at M/s
    Unemployed, Unemployed having drug licence number Nil.
    Please restore and renew my registration no. 30138 for a period of 3 years, from 1st January 2017 to
    31st December 2019.

    I am residing in Rajasthan and my address is as below:


    Old address, as given at time of registration: Present address:
    C-130, SUBHASH NAGAR (EXT.), NEAR C-130, Subhash Nagar (Ext.), Near Ram
    RAM MANDIR, BHILWARA, Bhilwara Mandir, Bhilwara, Bhilwara, Rajasthan,
    311001
    Mobile no.:7792921481

    The payment details are as below:


    Amount: 800/-, Mode of payment: Online Payment, Bank: Billdesk, Reference: 2433372 (18/09/2017
    )
    Declaration:
    I solemnly affirm that the information furnished above is true and correct in all respects. I have not concealed any information.
    I am aware that if any information furnished herein by me is found to be incorrect or untrue at any stage, my application for
    registration/renewal etc. as pharmacist is liable to be cancelled at any stage. In such a situation, I shall forgo my claim to the
    registration/renewal at the Rajasthan Pharmacy Council and I shall be liable to criminal prosecution. I agree to always abide
    by the Rules and Regulations of the Rajasthan Pharmacy Council.

    ---------------------------------------------------------------------------
    Signature of Pharmacist (As done at time of registration)
    ________________________________________________________________________________

    In case of new signature


    The signature is hereby attested by Gazetted officer

    ------------------------------------------------------------------------
    ------------------------------------------------------ Signature with seal
    Signature of Pharmacist

    Name and designation of Gazetted officer

    __________________________________________________________________________
    For office use
    Signature verified by _________________________
    Date:
    Enclosures:
    1. Fee payment document.
    Important: Send duly completed form along with above enclosures to “The Registrar, Rajasthan Pharmacy Council”

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