1

Roll No_________

PUNJAB PHARMACY COUNCIL, LAHORE.

(Established under Pharmacy Act, 1967)
ADMISSION FORM FOR
EXAMINATION OF PHARMACY ASSISTANT (REGISTRAR-B)
YEAR OF EXAMINATION______________________

Attested
Photograph to
be pasted here
by the applicant

THE REGISTRAR
PUNJAB PHARMACY COUNCIL
LAHORE
Sir,
I request for the permission to appear in the examination of the Punjab pharmacy council as provided
under section 29 of the pharmacy act 1976.i submit below the necessary particulars:1. Full Name: _____________________________________________________________________
2. Fathers Name: _________________________________________________________________
3. Date of Birth: ___________________ 4. Religion: ________________ 5. Caste: ______________
6. Must attach the following:
I) Matric certificate II) Apprenticeship certificate under pharmacy act 1976
III) Dispenser certificate of Punjab medical faculty, Enrollment No._________________
Iv) Registrar -c Enrollment No.______ _______ (Attach attested copies of all certificate)
7. Permanent Address: __________________________________________________________________
8. Postal Address: ______________________________________________________________________
9. Mark of identification: ___________________________ Phone No: ___________________________
10. N.B.P pay order No. /Bank draft no.____________________ Dated: __________________________
11. National identity card No: ____________________________________________________________
12. Matric certificate Roll No: ______________________ 13. E-Mail- ---------------------------------Signature (English) ____________________
Signature (Urdu)_____________________
( FOR COMPARTMENT EXEMPTED CANDIDATES ONLY)
Appear in _____________Examination held in the month___________year____________
Under Roll No. _______________________and is eligible to re-appear in the subject of
_____________________in the next one / two chance according to result card.
Dated the ____________________
FOR OFFICE USE ONLY
Admission from has been received. Enrollment certificate, Apprenticeship or Dispenser
certificate and other required documents have been checked admission
Fee has also been received. May be admitted please.
Prepare by (Exam. Clerk) ________________checked by (Assistant) ________________
Cash Receipt No.
_____________________________Accountant__________________________

The Examination Fee is RS.4000/-and if not paid on due date, after the expiry of due date double
fee amounting Rs.8000/-has to be remitted.
Four attested passport size photograph, photocopies of National identity Card, Enrollment certificate,
Metric, Dispenser, (if any), character and Apprenticeship certificate shall have to be attached.
(II) Incomplete form shall not be accepted.
TO BE FILLED BY CANDIDATE
Roll No. ____________________________

FOR ORIGINAL CERTIFICATE

Roll No. ____________________________

Name: _____________________________

Name: _____________________________

Fathers Name: ______________________

Fathers Name: ______________________

Address: ____________________________

Address: ____________________________

___________________________________

___________________________________

____________________________________

____________________________________

FOR RESULT INTIMATION

Roll No. ____________________________

FOR ROLL No. SLIP

Roll No. ____________________________

Name: _____________________________

Name: _____________________________

Fathers Name: ______________________

Fathers Name: ______________________

Address: ____________________________

Address: ____________________________

___________________________________

___________________________________

____________________________________

____________________________________

REGISTERED
ROLL No. _______
Candidate will be admitted in the Examination Hall production and delivery of this Roll Number slip.
Please bring your National identity card during theory and practical Examination.

PUNJAB PHARMACY COUNCIL, LAHORE

Admit Mr./Miss./Mrs. _________________________ S/o, D/o, W/o: _____________________
In the Examination being held on __________________________________________________
At center __________________________________at the _____________________________________

Attested
Photograph to be
pasted here by the

NOTE:Mobil Phone not allowed in the Examination hall.

applicant

__________________
Signature of candidate

REGISTRAR
PUNJAB PHARMACY COUNCIL

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Following documents must be submitted/attached with the application form:
1. Apprenticeship certificate as required under Pharmacy Act 1967, issued by a Pharmacist
regular employ of Government and notified by the Government of Punjab. (Not for dispenser).
Dispenser shall submit 4 attested photocopies of Dispenser Certificates.
2. Attested ID Card/Domicile.
3. Attested Photocopy of Metric Certificates. 4 Nos.
4. Recent Character Certificate issued by Class-1 Officer (Original)

5. Affidavit on Non-Judicial Paper of Rs. 20/- as prescribed

6. Attested Photographs 6 Nos.
7. Attested 3 specimen signature
8. Bank Draft for Examination Fee in the name of Secretary, Punjab Pharmacy Council, Rs. 4000/-.
9. Verification fee for the Intermediate Board concerned OR
Punjab Medical Faculty Rs. 500/- (if dispenser)
10. Attach all documents in a hard and fine file cover

Note:-

The above mentioned documents are not needed for supplementary exam,
Only pay fee Rs.4000/-

APPRENTICESHIP CERTIFICATE
Under Pharmacy Act, 1967

It is to certify that Mr./Miss. ______________________________________________________________

S/D/o _______________________________________________________________________________
Resident of __________________________________________________________________________
___________________________________________________________________________________

has taken as apprentice by the undersigned with effect from ______________________ for a period of
two years as required under Pharmacy Act, 1967.
He is working at M/s _______________________________________________________________
License No. __________________.

Sr. No.__________________
Date: ___________________
Signatures

Name _______________________
Address ______________________
Reg. Cert. No. _________________
Renewal Valid Upto ____________