Form G

FORM “G”
(RULE 69)
FORM OF APPLICATION FOR REGISTRATION OF PHARMACISTS
(Under section 32 of pharmacy Act. 1948)
To,
The Registrar
Gujarat State Pharmacy Council,
Old Nursing College Building, Block No. - 4/A,
3rd Floor, Opp. Cancer Hospital, Gate No. - 6,
Asarwa, Ahmedabad - 380016.
Dear Sir,
I request that my name, address and qualification as stated in the accompanying form may
be registered under the pharmacy Act, 1948 and that may be furnished with a certificate of
Registration.
I enclose herewith for your perusal and the return the certificate and diplomas in original
and their copies for the record.
A fee of Rs. 25 as required under rule 76 of the Bombay State Pharmacy Council Rules is
sent by Demand Draft or is paid in Cash to the Registrar in person.
I hereby declare that I have read carefully and understood the instructions and particulars
supplied to me and that all the entries in the form are true to the best of my knowledge and belief.
Yours faithfully
Date : Signature
INSTRUCTIONS
1. All particulars are of the application must be filled in by the applicant in neat, legible
hand, incomplete applications may be rejected.
2. The name entered in this application must exactly correspond with the name of the
applicant entered at the University or other examinations.
3. Application fees of Rs. 500/600 (including administrative charges) for registration
should be sent to the Registrar Gujarat State Pharmacy Council. Application fee should be
handed over in person by Cash or by Demand Draft payable at Ahmedabad only. When
fee is sent by the Demand Draft full name and address of the applicant to be given, else it
may be rejected.
4. If the space for giving particulars is not found sufficient, the same may be given on a
separate sheet and attached to this application.
5. If the applicant is a proprietor of any firm he should produce a declaration of his
experience in dispensing.
6. Dispensing experience under R.M.P. under act of 1938 cannot be accepted for the purpose
of section 31(d).
7. Experience in manufacture of Drugs cannot be accepted for the purpose of section 31(d).
ACCOMPANYING FORM
1. Name in full, beginning with

Surname (in block capitals)_________________________________________________
(Surname) (Name) (Father Name/Husband Name)
2. Place & Date of Birth ______________________ _________________________

(Birth Date) (Place Of Birth)
3. Nationality _______________________
4. Residential Address (in block capitals)
5. Address of business or profession

(in block capitals)
6. Description of qualification of
which registration in desired.
_____________________________________________________________________________
Degree or Diploma Institution Date of obtaining the Degree or Diploma
_____________________________________________________________________________
_____________________________________________________________________________
*7. Name Address Period of service From To
_____________________________________________________________________________
7.(a) Present employer :
(b) Previous employers :
Signature of the applicant

_____________________________________________________________________________
* Details of experience given against item No. 7 of the form should be supported by a certificate
in the form given below. If the applicant is unable for any reasons to furnish such a certificate a
declaration be made before a presidency or a Magistrate of class first.
Forwarding Letter
Full name & Address of Pharmacist
Telephone No. :
E-mail Id :
Date :
To,
The Registrar
Gujarat State Pharmacy Council,
Old Nursing College Building, Block No. - 4/A,
3rd Floor, Opp. Cancer Hospital, Gate No. - 6,
Asarwa, Ahmedabad - 380016.
SUB : REGISTRATION AS PHARMACIST
Sir,
With reference to the subject cited above, I Mr/Miss/Mrs.
________________________________________________________________ hereby apply in

(Surname) (Name) (Father’s/Husband Name)
the prescribed Application Form-G to enter my name in the Pharmacy Register maintained by the
Gujarat State Pharmacy Council under the provisions of Pharmacy Act, 1948.
I enclosed herewith photocopies or all the required documents and testimonials duly Self
attested and information as per the rules alongwith the application form as enlisted below in
chronological order for your perusal.
Sr. Particulars Whether Page
No. Enclosed No.
Yes/No.
1 2 3 4
1. Prescribed Application Form-G
2. One recent passport size photograph(5 X 4 Cms)
of the applicant
In case of any change in the name of the applicant (any of the
following documents)
(a) Marriage certificate (In the case
of married female candidate) or
(b) A copy of gazette notification (in all other cases)
3. Proof of birth date and Birth place :
School / College leaving certificate / S.S.C. Board certificate &
Birth Certificate from competent authority.
4. Proof of residence in the Gujarat
State such as (any of the following documents) :
(a) Electric or telephone bill in the name
of parent of the candidate.
(b) L.I.C. policy of the candidate.
(c) Identity card of the candidate Issued by the Election Commission.
5. (d) Tax Bill from the relevant authority
of panchayat or Nagarpalika or Municipal corporation
(e) Passport of the candidate.
OR
(f) Any Legal documents.
6. S.S.C. and H.S.C. Marks – sheet and certificate (Qualification on

which basis the admission to Diploma/Degree Course in pharmacy
had been taken by the candidate).
7. College bonafied / Course Completion certificate with period of
study.
8. College Leaving/Transfer Certificate mentioning date of admission
and period of completion of studies in pharmacy (In the case of
applicant who has passed Diploma/Degree in pharmacy
examination from an institution of other than Gujarat State).
9. Degree/Diploma in Pharmacy Mark – sheet of all years.
10. Degree/Diploma in Pharmacy Certificate obtained from relevant
University/Board of examination OR Provisional Certificate of the
University/Board.
11. Practical Training Completion Certificate duly completed Section-
I toV with seal and signature of the principal of the concerned
institute in Section-V of the Practical Training contract form
12. Proof of Employment/Business of the candidate as mentioned
under column No.7(a) & (b) in the Form-G.
(a) Employer’s Certificate mentioning period of service, designation,
head quarters, Salary etc. from relevant Firm/Company/Institution
mentioning Drugs Licence Nos, if any ; or
(b) In case of self employed persons
A self declaration on the letter pad of the relevant Firm/Company
etc. mentioning Drug License Nos. if any ; or
(c) (In the case of un-employed person) Undertaking for further
studies, if applicable (Annexure-A) or A self declaration of
non-practicing (Annexure-B).
13 An affidavit (as per specimen copy enclosed in the case of
applicant who has passed Diploma / Degree in Pharmacy
examination from an institution of Gujarat or other than Gujarat
State) (Annexure-C).
14 Undertaking and affidavit (as per specimen in the case of applicant
who has been registered as pharmacist in other state Council)
(Annexure-D).
15 Prescribed Registration fees (Rs.______________)(By cash or by
crossed Demand Draft in favour of “Gujarat State Pharmacy
Council” drawn on State Bank of India, Ahmedabad or any
schedule bank payable at Ahmedabad).
16 Self Addressed cover (36cms * 28cms) with postage stamp of Rs 40
I hereby certify and declare that I have studied the degree / diploma in pharmacy course from
____________________________________________________________________________
(Name of College)
during the years ______________________ and passed
from _________________________________________________________________________
(Name of University / Board of Examination)
in the year _________________
I hereby declare and undertake that all the documents, testimonials and all the
informations furnished by me to the Gujarat State Pharmacy Council along with the application
form are true to the best of my knowledge and belief and in case any of my informations,
documents or testimonials furnished by me is found to be, false or misleading then I shall be
liable to any action taken against me and my registration shall be liable to cancellation without
any notice.
I also understand and undertake that the prescribed application Form – G completed in all
respect along with all the required and duly attested supporting documents and testimonials (1 to
14) etc., if presented with prescribed fees by Cash / Crossed Demand Draft shall only be accepted
by the Council and incomplete application forms without any of the supporting documents shall
be rejected without entertaining any communication to me.
I hereby also declare that I have read carefully and understood all the instructions and
particulars supplied to me and all the entries therein are true to the best of my knowledge and
belief.
_________________________ _____________________________
(Place) (Signature of the pharmacist)
_________________________
(Date)
_____________________________________________________________________________
For office use :-
Checked by______________________________Verified by____________________________

(Signature & Date Sr. Clerk / Clerk) (Head Clerk)
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What are the requirements for registering as a pharmacist in Gujarat?

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FORM “G”

1. Name in full, beginning with

2. Place & Date of Birth ___

4. Residential Address (in block capitals)

5. Address of business or profession

(b) Previous employers :

Signature of the applicant

SUB : REGISTRATION AS PHARMACIST

________________________________________________________________ hereby apply in

6. S.S.C. and H.S.C. Marks – sheet and certificate (Qualification on

in the year _________________

For office use :-

Checked by__Verified by

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