APPLICATION FOR OPENING ZEELAB GENERIC PHARMACY at:
S.NO PARTICULARS DETAILS
1. Name Of The Applicant/Firm/ Company
2. Complete Address With State & Pin Code
3. Name Of The Pharmacist (Self /Employed)
Registration Number Of Pharmacist
4. Registration Number of the Organization & Date of Incorporation (if Applicable )
5. Name Of The Contact Person
Designation
Mobile No/ Landline No
Alternative No. ( If Any )
E-mail id
6. Aadhaar Card Number
7. PAN Number
Proposed Location For Opening Zeelab Generic Pharmacy
8. Area In Sq. ft
Owned or Leased
Address Line 1
Address Line 2
Block/ Taluka / Mandal
District
PIN Code
State
9. Education Qualification
10. Current Occupation
11. Details of Your Past Experience
12. Investment Proposed
13. No. of Shops Required
14. Do you have Prior Experience in Pharmacy/Pharmaceuticals/retail
15. Please Provide two Market References with Contact No. 1.
2.
Declaration: I Have gone through the terms and condition as mentioned in the guidelines for opening of Zeelab Generic Pharmacy and agree to abide by the same. I/We hereby declare that all the information as mentioned above is true to best of my knowledge . If any information is found to be incorrect, my/our candidature is liable to be cancelled and may be subject to legal/disciplinary proceeding.

Copyright 2019 ZEELAB GENERIC. All rights reserved.

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