APPLICATION FOR FRESH REGISTRATION OF PHARMACIST

Applicant's Personal Information :

(As per Qualifying Certificate)

(As per Qualifying Certificate / SSLC)

( as per SSLC or 10th, Cumulative Record / 10th School Leaving Certificate / Birth Certificate / Transfer Certificate / Passport / Pan Card)

Login Details :

(Password must be of minimum 8 characters of alpha numeric type. (eg. abcd1234 )

Address

Residential address in Karnataka

Permanent Address : (As per Adhaar / Passport / Voter-id)