THE HONG KONG GOVERNMENT GAZETTE, MAY 5, 1939.
hereby certify that I am acquainted with (b)
and with (c)
and that (b)
whom (d)
supplied by (c)
I further certify that (e)
is the signature of the said (b)
Date
.is a person to
may properly be
Signature of person giving certificate.
(a) Insert full postal address.
(b) Insert full name of intending purchaser.
(c) Insert full name of intending seller. (d) Insert name of poison.
(e) Intending purchaser to sign here.
35. Every application made for the entry of a name on the registrar's list in pursuance of section 22 (1) of the Ordinance, being a list of persons entitled, subject to the provisions of the Ordinance and of these Regulations, to sell poisons included in Part II of the Poisons List, shall be made in the form set out hereunder.
PHARMACY AND POISONS ORDINANCE, 1937.
Form of application by a person to have his name entered in the Registrar's list of persons entitled to sell poisons included in Part II of the Poisons List.
TO THE DIRECTOR OF MEDICAL SERVICES,
HONG KONG.
Form of
application to Registrar,
I,
being engaged in the business of
hereby apply to have my name entered in the list kept in pursuance of section 22 of the above Ordinance in respect of the following premises, namely,
as a person entitled to sell from those premises poisons included in Part II of the Poisons List.
Signature of applicant
Date
431
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