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Name of all the partners or Directors,
proprietor, etc and full residential address of each- |
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| (5)
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2. What are the educational qualifications of-
(a) The applicant or/and |
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| (b) Person in charge of the premises
for
which licence is applied for |
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3. What was the business carried on byhe applicant
within last three years ?
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4. Has the applicant ever engaged himself or on
behalf of any other person in sellingdrugs
any time prior to this application ? Ifso,
the dates together with necessarydocumentary
evidence may be supplied.
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5.
What other business is carried on by theapplicant
at present ? | |
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6.
Is the application for fresh licence orrenewal
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7. Year in which licence was first granted.
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8. Particulars of licences granted under DrugsRules
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Licence No. Date of issue
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9. Was the application ever rejected orlicence
previously cancelled or suspendedor
surrendered ? If so, for what reason ?
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10.Was the applicant ever warned for sellinggoods
which were not of standardquality
?
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11. Was the applicant or any person atpresent
employed by him on thesepremises
ever convicted and sentencedunder:-
(a) Drugs & Cosmetics Act-1940
(b) Dangerous Drugs Act 1930
(c) Bombay Prohibition Act, 1949
(d) Bombay Drugs ( Control ) Act, 1952
(e) The Poisons Act, 1919
(f)
The Pharmacy Act, 1948 |
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12. (a) Poisons Rules
(c) Dangerous Drugs Rules
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Licence No. Date of issue
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13. Sale of Intoxicants Taxation Act
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Licence No. Date of issue
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14. Spirituous Medicinal Preparations Rules
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Licence No. Date of issue
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15. Sales Tax Registration No.
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Date of registration |
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16. Shop and Establishment Act
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Licence No.
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17. Has the applicant ever imported
Spirituous
Medicinal or ToiletPreparations
from other States ? If so, astatement
of the names of themanufacturers,
Spirituous Preparations ,their
quantities and dates on whichimported
during the last yearshould
be given in a separate sheet ofpaper
duly signed and dated by theapplicant.
And / or Had the applicantever
dealt in Spirituous MedicinalPreparations
or Toilet Preparationsmanufactured
by manufacturers withinthis
State ? | |
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18. Is the applicant an agent or distributor ofany
drug manufacturing concern ? If so, the
area of distribution and date of appointment
should be stated with full particulars.
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19. Is the firm or company
(a)
Restaurant ?
(b)
Grocer ?
(c)
Panbidi Shop ?
(d)
General Merchant ?
(e)
Medical Store ?
(f)
Dispensing Chemist ?
(f) Distributing
Agency ?
(g) Commission
Agent ?
(h)
Importer ?
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20. The applicant has in all
..rooms forstorage
and sale of drugs. The floor areain
square feet of each room must be givenwith
a sketch.
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The applicant is / is not a legal tenant or alicensee
thereof. Necessary documentary evidence
should be enclosed. | |
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21. The applicant does/does not stock or sell drugs
at any other premises nor has the office
except at the premises for which this
application is foror
The address
of other premises are :-
1
2
3
4 |
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22. What class of drugs are stocked, sold or
distributed :-
(a) Poisons
(b) Injections
(c) Oral Vitamin Products
(d) Household Remedies
(e) Tinctures and other Spirituous
Preparations
(f)
Ayurvedic Medicines ?
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23. The applicant deals in the following class of
commodities only besides drugs on these
premises, viz :-
1.
2.
3.
4.
5.
6.
7. |
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24. The applicant was / was not dealing inSpirits/
Wine Country Liquor prior tointroduction
of Prohibition in Bombay.
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25. The applicant will deal/will not deal inany
Spirituous Medicinal or ToiletPreparations
which are liable to bemisused
for other than bonafied
medicinal purpose. |
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26. Hours of business and working days
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27. Name of the trade or professionalAssociation
of which applicant is amember
and the date of commencementof
membership.
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