Health Department 40[FORM 19 [See Rule 59(2)] Application for grant or renewal of a 40a[licence to sell, stock, exhibit or offer for sale, or distribute] drugs other than those specified in Schedule X 1. I/We......... 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 persons namely :- .................. (Name) .................. (Qualification). .................. (Name) .................. (Qualification). 3. Categories of drugs to be sold. 4. + Particulars for special storage accommodation. 5. A fee of rupees........ has been credited to the Government account under the head of account............... Date.......... Signature.........] * Delete whichever is not applicable. $ To be deleted if drugs will be sold only by wholesale. + Required only if products requiring special storage are to be sold.
