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Pakistan Chemist and Druggist Association New Membership Form


Pakistan Chemist and Druggist Association New Membership Form. Copyright PCDA

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									                             MEMBERSHIP APPLICATION FORM
The Secretary General,
Pakistan Chemists & Druggists Association,
18, Shiekh Chambers, Light House, M. A. Jinnah Road,
Dear Sir,
       Being desirous becoming the member of the “Pakistan Chemists & Druggists Association”. I/We agree to
abide its Memorandum & Articles of Association. Particulars of my/our business are given over leaf. Necessary
documents are required are enclosed. I/We solemnly declare that the particulars given below are true to the
best of my / our knowledge & belief.

Date: _______________________ Yours Faithfully _________________________________________________

Stamp of the Applying Firm / company ________________________ Signature of Applicant ________________

Proposed by M/S: ____________________________________________________________________________

PCDA Member No.____________________ Signature with Stamp_____________________________________

Address: ___________________________________________________________________________________

Seconded By M/S: ___________________________________________________________________________

PCDA Member No. ____________________ Signature with Stamp ____________________________________

Address: ___________________________________________________________________________________

                             Required Documentation
              For Associate Membership         For Corporate Membership
       Copy of NTN Certificate                               Copy of NTN Certificate
       Copy of CNIC of Proprietor / Owner / Partner.         Copy of GST Certificate.
       2 Photo of Proprietor/Owner.                          Copy of CNIC of Proprietor / Owner / Partner
       Copy of latest Income Tax Returned (ITR).                / Authorized person.
       Copy of Partnership Deed and letter of                2 Photo of Proprietor/Owner/Authorized
            authorized person. (If Applicable).                  Person.
       Valid Drug Sales License.                             Copy of latest Income Tax Returned (ITR).
                                                              Proof of Five million Turn over/year. (If
                                                              Valid Drug Sales License.

                                         For Office Use Only:
Checked by Scrutiny Committee ___________________________________________ Date: ________________

Approved By: Chairman Scrutiny Committee. _______________________________Date: __________________

Received a sum of Rs. ______________ by Cash/Cheque No. _________________ Vide Receipt No. _________
Dated: _____________On account of admission fee and annual subscription fee for the year _______________
Membership Code No.________________________ Members of the Scrutiny Committee approved in its
meeting held on___________.
                        Pakistan Chemists & Druggists Association
                                18, Sheikh Manssor Chambers, Near Light House Cinema,
                               M.A.Jinnah Road, Karachi. Ph: 021-332732387 Fax: 32732486
                          Email: www.pcdapakistan@gmail.com Website: www.pcdapakistan.com

                                        Particulars of Applicant                               Photograph

1.      Title of the Firm/Company _______________________________________________________________

2.      Full Address: __________________________________________________________________________

Class of Membership Desired: (Corporate Group/Associate Group) ____________________________________

3.      Manufacturer/Exporter/Importer/Distributor/Wholesaler/Retailer/Surgical & Diagnostic Items or any
other Pharma related business, please specify ____________________________________________________

4.      NTN No. ____________________________.GST No. __________________________________________.
                                                               (For Corporate Member)

5.      Registration with SECP (For PVT LTD Company). ______________________________________________

6.      Tel. (Office):__________________________________ Tel (Res) _________________________________

7.      Cell No.______________________________________ Fax No.__________________________________

8.      Email: __________________________________ Website ______________________________________

9.      Person who will represent the Firm/Company in the PCDA. (Only for Partnership/PVT. Ltd Firm)

Name: __________________________________ Designation _____________________________________

Drug Sale License No.____________________ Expiry Date _______________.

Signature & Stamp of the Applicant. ___________________________________________________________

10.     Name of the partners/directors: (Only for AOP/PVT. LTD/ Corporate Member)

i.      _____________________________________             ii. ______________________________________

iii. _____________________________________                iv.______________________________________

v.    _____________________________________               vi.______________________________________

vii. _____________________________________                viii._____________________________________

ix. _____________________________________                 x. ______________________________________

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