[reg. 42(3).]
1987 Ed.]
Pharmacy and Poisons Regulations
[CAP. 138
A 73
[Subsidiary]
表格十
PHARMACY AND POISONS ORDINANCE
藥劑及毒藥條例
(Chapter 138)
(香港法例第一三八章)
FORM OF ENTRY TO BE MADE IN THE BOOK TO BE KEPT BY SELLERS OF POISONS IN ACCORDANCE WITH SECTION 22(3)
根據條例第二二條第(三)款毒藥售賣商須在其所保存之登記冊內登記之事項之表格
售賣日期 Name and quantity of poison supplied
所供給毒藥之名稱及份量 Purchaser's Details
購買人詳情 Purpose for which stated certificate required
購買人自稱須購買該毒藥之目的 Date of certificate (if any)
如有證明書，則填寫簽發日期 Name and address of person giving certificate (if any)
如有證明書，則填寫發給者之姓名及地址 Signature of purchaser (or reference number of Signed order in case of wholesale)
購買人簽署(或如屬批發，則填寫已簽署之訂單之參考號碼) Signature of registered pharmacist
註冊藥劑師簽署 Name
姓名
Address
地址
Business, trade or occupation
所從事之業務、行業或職業
〔規例第四二條第(三)款