Form 8
[See rule 19 (1)]
Application for a license to sell, stock and exhibit for sale and distribute drugs and
therapeutic goods.
1. I/we ABDULLAH KHAN owner of M/S NEW KHAN MEDICAL STORE
hereby apply for a license to sell:
a. Drugs and therapeutic goods by way of retail sale.
b. Drugs and therapeutic goods by way of whole sale / Distribution
c. License to sale Narcotics and other controlled drugs
d. License to sale in Pharmacy / by way of formulation
e. License to sale in Veterinary.
f. License to sale Medical devices
on the premises situated at YASEEN PLAZA , EIDGA ROAD ZHOB
2. The sale of drugs will be under the personal supervision of :
(Name) SHAHID KHAN (Qualification) PHARM D
3. I / We, am / are submitting herewith the following documents:
a) attested copies of the testimonials of Qualified person including Pharmacy council
registration certificate.
b) two copies of national identity card of the proprietor and qualified person
c) four attested copies of the photograph of qualified person
d) attested Photostat copy of the valid registration issued by the C.O.I & E in case of
indenter / importer.
e) Manufacturer's Authority as agent / distributor.
f) Affidavit of the Proprietor duly verified from Class-I Magistrate that:
(i) will abide by the provisions of Drugs Act, 1976, DRAP Act 2012 and Drug
Licensing Rule 2021.
(ii) will inform authorities well in time if any change in service or address occurred or
any irregularity or any violation of Drug Act 1976, DRAP Act 2012 is noted.
(iii) Shall not sell / stock any expired, spurious, sub-standard, unregistered,
misbranded, unwarranted, counterfeit or any drugs and therapeutic goods in
violation to the drugs laws in force.
g) Affidavit of the Qualified person who will supervise the sale of drugs and therapeutic
goods, duly verified by Class-I Magistrate (specimen is in Schedule D).
h) Treasury Challan(s) No. 2 & Dated 02-05-2024 amounting to Rs. 10000 in the
Head of Account C-_______-Health and Other receipts.
Dated:_______/_______/20_______ Dated:_______/_______/20________
Signature:_____________________ Signature:______________________
Name, address and Permanent Home address of Qualified person Name, address and Permanent Home address of proprietor
Page 1 Generated By: Drugs license Managment System, Provincial Directorate of Health, Quetta Date 15-12-24
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PROVINCIAL DIRECTORATE OF HEALTH
GOVERNMENT OF BALOCHISTAN, QUETTA
Phone No. +000000000 website: www.dghs.gob.pk
APPLICATION FOR PHARMACY STORE LICENSE
PHARMACIST PERSONAL DETAILS INFORMATION
Pharmacist Name: SHAHID KHAN
Father's Name: HALIM JAN
Pharmacist CNIC NO: 5650384699323 Cell NO: 03108097598
Local/Domicile : ZHOB Serving: NO
Qualification: PHARM D Passing Year: 2023
PCP Registration NO: 2341-A/2024 Valid till: 17-01-2029
PROPRIETOR PERSONAL DETAILS INFORMATION
Proprietor Name: ABDULLAH KHAN
Father's Name: MUHAMMAD KHAN
Proprietor CNIC NO: 5650397486801 Cell NO: 03318100664
Qualification: MATRICULATION
PHARMACY STORE DETAILS INFORMATION
Store Type (Category): DRUG BY WAY OF RETAIL SALE
Pharmacy Store Name: NEW KHAN MEDICAL STORE
Store Address: YASEEN PLAZA , EIDGA ROAD ZHOB
0010866
Page 2 Generated By: Drugs license Managment System, Provincial Directorate of Health, Quetta Date 15-12-24
