Transaction Details

Licensee Details

Licensee Qualification

Proprietorship Details

Uploaded Document Details

1. Identity Document of Applicant()
2. Photograph & Signature of Applicant
3. Identity Document of Pharmacist()
4. Photograph & Signature of Pharmacist
5. Pharmacist Registration Certificate / Competent / Person Qualification Certificate

1. Drug Licence Registration Certificate

Download Application Form

Acknowledgement under the LSG Act. 2010

Form 19
[see rule 59(2)]

Application for grant or renewal of a licence to sell, stock,
exhibit or offer for sale or distribution of drugs other than those specified in Schedule X

hereby apply for licence to sell by *** wholesale/retail.drugs specified.in.Schedules.C and C (1) excluding those specified in Schedule X and/or drugs other than those specified in Schedules C, C( 1 ) and X to the Drugs and Cosmetics Rules, 1945 and also to operate a pharmacy on the premises situated at :

2. The sale and dispensing of drugs will be made under the personal supervision of the  qualified pharmacist and/or competent person(s) namely

3. Categories of drugs to be sold _________________AS PER RULES_____________________________________

4. * * * * Particulars for special storage accommodation.

A fee of rupees has been credited to Government under the head of account 0210 Medical and Public Health, 04 Public Health, 104 Fees and fines, (5) Lic Fees under Drugs and Cosmetics Rules.

* Please mention full name of applicant (including father's/husband's name), Residential Address and Telephone no. if any along with the name of the shop/firm company. ** Please mention the name of shop. *** Delete whichever is not applicable. ****Required only if products requiring special storage are to be sold.

Form 19-A
[see rule 59(2)]

Application for grant or renewal of a restricted licence to sell, stock, exhibit [or offer for] sale, or distribute drugs by retail by dealers who do not engage the services of a qualified person

hereby apply for a licence to sell by retail (i) Drugs other than those specified in Schedules C,C (1) and X on the premises situated at

(ii) Drugs specified in Schedule C(1 ) on the premises situated at

Drugs specified in Schedule C(1) as vender in the area _______________________________________________

2. Sales shall be restricted to such drugs as can be sold without the supervision of a qualified person under the Drugs and Cosmetics Rules.

3. Names or classes of drugs proposed to be sold ___________________________________________________

4.*** Particulars of the storage accommodation for the storage of Schedule C(1) drugs on the premises referred to above.

5.**** The drugs for sale will be purchased from the following dealers and such other dealers as may be endorsed on the licence by the Licensing Authority from time to time.

6. A fee of Rupees has been credited to Government under the head of account 0210 Medical and Public Health, 04 Public Health, 104 Fees and Fines, (5) Lic. Fees under Drugs and cosmetics Rules. vide treasury receipt attached.

* Please mention the name (including father's/Husband's name, residential address and Telephone number if any.
* * Please mention the name of the shop.
* * * Delete if not required.
* * * * Applies only to an itinerant vendor.