1964_PHARMACY_AND_POISONS_REGULATIONS — Page 77

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1987 Ed.]

Pharmacy and Poisons Regulations

[CAP. 138

A 77

[reg. 24B(a).]

[Subsidiary]

L.N. 85/87.

FORM 15

PHARMACY AND POISONS ORDINANCE

(Chapter 138)

APPLICATION FOR REGISTRATION OF PREMISES

UNDER SECTION 13

We

(Name of business)

of

(Address of business)

wish to apply for the registration under section 13 of the Pharmacy and Poisons Ordinance of the premises as set out in paragraph 1 of this application to conduct the retail sale of poisons at such premises.

1.

Address of premises

2.

Name of business at the premises

3.

Business Registration No.

4.

Telephone No. of the premises

5.

Name of registered pharmacist in whose presence or under whose supervision the retail sale of poisons is conducted under section 11(1) of the Ordinance

In support of this application, we submit a copy of the certificate of registration of the pharmacist named in paragraph 5.

Signature

Full name of signatory

Signed on behalf of

(Name of business)

Date

本號......

是

表格十五

藥劑及毒藥條例

(香港法例第一三八章)

根據藥劑及毒藥條例第十三條呈遞的樓宇註冊申請書

[規例第二十四條(a)段]

(商號名稱)

(商號地址)

現根據藥劑及毒藥條例第十三條的規定，申請本申請書第一段所述樓宇註冊，以便在該樓宇內經營毒藥零售業務。

1. 樓宇地址......

2. 設在該樓宇的商號名稱

3. 商業登記號碼......

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1987 Ed.] Pharmacy and Poisons Regulations [CAP. 138 A 77 [reg. 24B(a).] [Subsidiary] L.N. 85/87. FORM 15 PHARMACY AND POISONS ORDINANCE (Chapter 138) APPLICATION FOR REGISTRATION OF PREMISES UNDER SECTION 13 We (Name of business) of (Address of business) wish to apply for the registration under section 13 of the Pharmacy and Poisons Ordinance of the premises as set out in paragraph 1 of this application to conduct the retail sale of poisons at such premises. 1. Address of premises 2. Name of business at the premises 3. Business Registration No. 4. Telephone No. of the premises 5. Name of registered pharmacist in whose presence or under whose supervision the retail sale of poisons is conducted under section 11(1) of the Ordinance In support of this application, we submit a copy of the certificate of registration of the pharmacist named in paragraph 5. Signature Full name of signatory Signed on behalf of (Name of business) Date 本號...... 是 表格十五 藥劑及毒藥條例 (香港法例第一三八章) 根據藥劑及毒藥條例第十三條呈遞的樓宇註冊申請書 [規例第二十四條(a)段] (商號名稱) (商號地址) 現根據藥劑及毒藥條例第十三條的規定，申請本申請書第一段所述樓宇註冊，以便在該樓宇內經營毒藥零售業務。 1. 樓宇地址...... 2. 設在該樓宇的商號名稱 3. 商業登記號碼......
Baseline (Original)
1987 Ed.] Pharmacy and Poisons Regulations [CAP. 138 A 77 [reg. 24B(a).] [Subsidiary] L.N. 85/87. FORM 15 PHARMACY AND POISONS ORDINANCE (Chapter 138) APPLICATION FOR REGISTRATION OF PREMISES UNDER SECTION 13 We (Name of business) of (Address of business) wish to apply for the registration under section 13 of the Pharmacy and Poisons Ordinance of the premises as set out in paragraph 1 of this application to conduct the retail sale of poisons at such premises. 1. Address of premises 2. Name of business at the premises 3. Business Registration No. 4. Telephone No. of the premises 5. Name of registered pharmacist in whose presence or under whose supervision the retail sale of poisons is conducted under section 11(1) of the Ordinance In support of this application, we submit a copy of the certificate of registration of the pharmacist named in paragraph 5. Signature Full name of signatory Signed on behalf of (Name of business) Date 本號..... 是 表格十五 藥劑及毒藥條例 (香港法例第一三八章) 根據藥劑及毒藥條例第十三條 呈遞的樓宇註册申請書 [規例第二十四條(a)段) (商號名稱) (商號地址) .地址 現根據藥劑及毒藥條例第十三條的規定,申請本申請書第一段所述樓宇註冊,以便 在該樓宇內經營毒藥零售業務。 1. 樓宇地址.... 2. 設在該樓宇的商號名稱 3. 商業登記號碼.
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1987 Ed.]

Pharmacy and Poisons Regulations

[CAP. 138

A 77

[reg. 24B(a).]

[Subsidiary]

L.N. 85/87.

FORM 15

PHARMACY AND POISONS ORDINANCE

(Chapter 138)

APPLICATION FOR REGISTRATION OF PREMISES

UNDER SECTION 13

We

(Name of business)

of

(Address of business)

wish to apply for the registration under section 13 of the Pharmacy and Poisons Ordinance of the premises as set out in paragraph 1 of this application to conduct the retail sale of poisons at such premises.

1.

Address of premises

2.

Name of business at the premises

3.

Business Registration No.

4. Telephone No. of the premises

5.

Name of registered pharmacist in whose presence or under whose supervision the retail sale of poisons is conducted under section 11(1) of the Ordinance

In support of this application, we submit a copy of the certificate of registration of the pharmacist named in paragraph 5.

Signature

Full name of signatory

Signed on behalf of

(Name of business)

Date

本號.....

是

表格十五

藥劑及毒藥條例

(香港法例第一三八章)

根據藥劑及毒藥條例第十三條 呈遞的樓宇註册申請書

[規例第二十四條(a)段)

(商號名稱)

(商號地址)

.地址

現根據藥劑及毒藥條例第十三條的規定,申請本申請書第一段所述樓宇註冊,以便 在該樓宇內經營毒藥零售業務。

1. 樓宇地址....

2. 設在該樓宇的商號名稱

3. 商業登記號碼.

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