PROFORMA FOR APPLICATION FOR LICENSE FOR MANUFACTURING OF AYURVEDIC/UNANI/HOMOEOPATHIC/SIDHA DRUGS.

Section I (General Information)

Application for *

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Bank Draft Detail (Payable at Punjab National Bank,Kasumpati, Shimla-9 in the name of Director of Ayurveda, Himachal Pradesh) *

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1.) Name of Sole proprietor/Firm Company/Co-op.Socieity etc. *

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2.) Nature of Organization *

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3.) Registered Office/Head office. *

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4.) Name(s) of Sole Proprietor / Member of Board of Directors / Company

5.) (I) Authorized capital

(II) Subscribed capital

(III) Permanent address

6.) Name of Manager / Chief Executive:

7.) Location of the factory: *

Place / Plot

Street

District *

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Tehsil

Distance from Road

Section - II

8.) Building Specifications - I

Sr. No.

Own / rented

Total Area of Land

Total construction plinth area of building

Number / size of rooms

Sr. No.

Own / rented

Total Area of Land

Total construction plinth area of building

Number / size of rooms

Building Specifications - II

Sr. No.

Type of construction

Specification of floor / room

Total estimated / actual cost of construction

Annual rent, if rented

Sr. No.

Type of construction

Specification of floor / room

Total estimated / actual cost of construction

Annual rent, if rented

9.) Name & Permanent address of Technical Persons

Sr. No.

Name

Qualifications

Address

Sr. No.

Name

Qualifications

Address

Section - III

10.) Source of Water

11.) Name of toxic inflamable or other suchmaterial to be used in products during the process.

12.) Name of drugs and quantity proposed to be manufactured give information

Sr. No.

Name of drugs

Quantity Proposed

Sr. No.

Name of drugs

Quantity Proposed

13.) Details of loan raised / proposed to be raised

Sr. No.

Source

Amount

Sr. No.

Source

Amount

14.) Normal working hours of the factory

15.) Any other relevant information

16.) Old Licence no. (In case of Renewal licence)

Old Licence issue date (In case of Renewal licence)

17.) Loan given to (In case of loan licence)

Declaration

1. We here by certify that the information given in the application is correct and nothing has been concealed therein. I/We understand that if the license is granted/renewed on the basis of above information and if any information/part thereof is found incorrect/false the licensing authority may cancel/revoke/suspend the license.

2. I/We do hereby undertake to abide by all provisions of the drugs and Cosmetics Act, 1940 and the rules made there under any other legislature enacted by the Central Govt / State Govt. Or local authority relating to manufacture and sale of drugs.

3. I/We further undertake to abide by all direction of the Licensing Authority or any other officer authorized by him this behalf, relating to manufacture/quality control and sale of drugs.

I Agree *