1964_PHARMACY_AND_POISONS_REGULATIONS — Page 73

[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

Purchaser's 購買人詳情

Business,

trade or

之登記冊內登記之事項之表格

to be

Date of

Sale

售賣日期

Name

and

quantity of

poison

supplied

Name

Purpose

for which

Date of

stated

certificate

Address

所供給毒

藥之名稱

姓名

地址

及份量

occupation

所從事之

業務、行

業或職業

required

購買人自稱

須購買該毒

藥之目的

(if any)

如有證明書,

則填寫簽發

日期

(if any)

如有證明書,

則填寫發給者

之姓名及地址

〔規例第四二條第(三)款

Name and

address of

person giving

certificate

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