This Receipt Issued Under Section 34 of Pharmacy Act 1948 .: Home Page

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Note:-   This receipt issued under section 34 of Pharmacy act 1948 .


Transaction Details

Application Number

Transaction Id lblTransNo

Transaction Date lblDate

Kiosk Id lblKioskId

Kiosk Name lblKioskName

Late Fee

Renewal Fee

Application Fee 100

Portal Fee 100

Total Amount lblAmnt/-


Personal Details

Application Number

Registration No : Registration No :

Applicant Name :

Father/Husband Name :

Mother Name :

Gender :

Date Of Birth : (DD/MM/YYYY) Age As On Date

Palace Of Birth :

Mobile Number : Email Id :

Nationality : Domicile :

Residential Address

Address : Pincode :

State : District :

Permanent Address

Address : Pincode :

State : District :

Experience (Year)

Total Experience:

Employed Details

Employed In Or Attached To Government Of State Aided Institute :

State : Name :

Address : Date : (DD/MM/YYYY)

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