Registration.
Form
(*) Required field
Name of Farm:
*
Name Of Propreitor/ Partners / Director:
*
Address of Farm:
*
Constituency:
*
Police Station:
*
Post Office:
*
Village + Ward:
*
District:
*
pincode:
*
Phone No.:
*
Alternate Phone No.:
e-mail:
Nature of Business:
*
Wholesale
Retail
Drug License No. :
*
Competant Person (W/R):
License No. of the Pharmacist: