Application Form for Registration in JK Pharmacy Council.

Instructions to fill the Form

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Application form for:
Is Your institution
Approved by PCI:
 Are You a Registered Pharmacist with any other Pharmacy Council located outside the borders of UT of J&K ?
Details of respective State Pharmacy Council where your institution/university is located, if registered.
Name of Pharmacy Council:
 Email of Pharmacy Council:
 Mobile no of Pharmacy Council:
Address of Pharmacy Council:
 Registration no
 Registration Date
Valid upto
APPLICANT DETAILS
Name of the Applicant:
 Gender:  Male Female
Father/Hubsand's Name
 Mother's Name
 Nationality

Date of Birth

Mobile No.

Alternate Mobile No.
Telephone No Email: Aadhar Card No:
Permanent Address

State/UT

District

Pin Code

My Correspondence Address is same as Permanent Address
Correspondence Address

District

Pin Code
Address of Hospital/Dispencery/Other place in which Employee at present

 Name of Employer:
 Are You a License Holder ?


Caste :
SC    ST    OBC    RBA    General    Others   


Religion:
Hinduism    Muslim    Sikhism    Christianity    Jainism    Buddhism    Others