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    Maharashtra State Pharmacy Council - Print Form

    Uploaded by

    Niketan Mese

    Copyright:

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

    Maharashtra State Pharmacy Council - Print Form

    Uploaded by

    Niketan Mese
    13 views2 pages

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    13 views2 pages

    Maharashtra State Pharmacy Council - Print Form

    Uploaded by

    Niketan Mese

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Maharashtra State Pharmacy Council

    (Constituted Under Pharmacy Act 1948 of Govt Of India)

    Application Form

    22001022451643
    Application ID - 261023 Application Type - New Registration Application Date - 22/11/2022

    Name - NIKETAN SIDHAPPA MESE Date Of Birth - 22/10/2000 Gender - Male


    Email ID - Mobile Nos - 7263808860 Nationality - INDIAN
    [email protected]
    Old Name - IsChangeOfName - No

    Permanent Address Local Address Professional Address


    AT POST BHANDARKAVTHE TAL. AT POST BHANDARKAVTHE TAL. ,,,,,
    SOUTH SOLAPUR, , SOUTH SOLAPUR SOUTH SOLAPUR, , SOUTH SOLAPUR
    , SOLAPUR, MAHARASHTRA, 413221 , SOLAPUR, MAHARASHTRA, 413221

    Qualification Details #
    Sr.No. Course Institute Date Of Passing

    1 B.Pharm D.S.T.S. MANDAL'S COLLEGE OF PHARMACY 15/09/2022

    Fee Details # Documents Uploaded #


    Sr.No. Particulars Amount Sr.No. Document Name

    1 Application Fee 25.00 1 Undertaking for New Registration


    2 Registration Fee 100.00 2 B.Pharm Final Year Marksheet
    3 Postal and Incidental charges 100.00 3 B.Pharm Provisional / Convocation
    4 Service Charges 500.00 4 Pharmacy College Leaving Certificate
    5 DIC Publications (Optional) 250.00 5 SSC Passing Certificate
    6 PPP charges 100.00 6 Identity Slip ( Attested by Principal of your College)
    7 PPP Renewal 100.00 7 Address Proof
    Advance Renewal Fees in Lumpsum Identity Proof(Any One): PAN card, Aadhar card,
    8 1500.00 8
    (ARFL) Passport, Election Card
    Other Document (Board Certificate/ Domicile / Birth/
    9
    Affidavit ) etc.

    Payment Details #
    Reference Nos Date Amount

    DUK2169727 22-11-2022 00:00:00 2675.00


    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 as pharmacist is liable to be cancelled at any stage. In such a situation, I shall forgo my claim to the registration at
    the Maharashtra State Pharmacy Council and I shall be liable to action under law. I agree to always abide by the rules and
    regulations of the Maharashtra State Pharmacy Council. I am aware Registrar, Maharashtra State Pharmacy Council can ask for
    additional documents and/or call in person at any stage of processing of application for registration and/or carry out necessary
    verification from concerned authorities as per nature of case.

    Signature
    NIKETAN SIDHAPPA MESE
    Instructions #

    Please keep the printout of the application form for your future reference.

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