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    Registration Process

    Uploaded by

    Tushar
    This document is a staff declaration form for the Pharmacy Council of India. It collects information such as the employee's name, date of birth, qualifications, designations, experience, contact information, employment history, income details, and declarations that the information provided is true. The employee and director must both sign the form to certify the accuracy of the information.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Registration Process

    Uploaded by

    Tushar
    9 views3 pages
    This document is a staff declaration form for the Pharmacy Council of India. It collects information such as the employee's name, date of birth, qualifications, designations, experience, contact information, employment history, income details, and declarations that the information provided is true. The employee and director must both sign the form to certify the accuracy of the information.

    Original Description:

    D pharma

    Original Title

    Registration process

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    This document is a staff declaration form for the Pharmacy Council of India. It collects information such as the employee's name, date of birth, qualifications, designations, experience, contact information, employment history, income details, and declarations that the information provided is true. The employee and director must both sign the form to certify the accuracy of the information.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    9 views3 pages

    Registration Process

    Uploaded by

    Tushar
    This document is a staff declaration form for the Pharmacy Council of India. It collects information such as the employee's name, date of birth, qualifications, designations, experience, contact information, employment history, income details, and declarations that the information provided is true. The employee and director must both sign the form to certify the accuracy of the information.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    PHARMACY COUNCIL OF INDIA

    STAFF DECLARATION FORM

    From

    Teacher’s Name ………………………………………………………


    (as on University Degree certificate)

    Recent Passport size photo of the Employee Photograph


    Signed by Dean/Principal of the College.

    Date of Birth & Age ………………………………………………………

    Qualification College & Year Registration No. Name of the State


    University with State Pharmacy Council
    Pharmacy Council
    B.Pharm

    M.Pharm

    (Ph.D.)/others

    Copies of Registration Certificate and University degree/PG/Ph.D. be attached.

    Present Designation :

    Department :

    College :

    City :

    Nature of appointment : Permanent/Temporary/Adhoc/Honorary/Part-time

    Whether belongs to : O.G./SC/ST/OBC/Ex-service/Others

    Contd. on page 2
    ::2::

    Permanent Residential
    Address of employee : _

    Copy of Passport/Voter Card/Ration Card/PAN No./Electricity Bill/Driving License


    Attached as a proof of residence.

    STD Code Phone No.

    Phone & Fax Number Office :


    with Code
    Residence :

    E-mail address :

    Date of joining present institution : as


    (Designation)

    Details of the previous appointments/teaching experience

    Position Name of Institution From To Total Experience


    in years
    Lecturer

    Reader/
    Assistant
    Professor

    Professor

    Principal

    1) Before joining present institution I was working at as


    and relieved on after
    resigning/retiring (relieving order is enclosed from the previous institution).

    2) I, hereby undertake that I have not given my name as teaching faculty in any other
    Pharmacy institution for teaching any Pharmacy course and not working in any where
    other than this institution Pharmacy College/Medical College/Dental
    College/Industry/Community Pharmacy/Hospital Pharmacy/Govt. Service/any other
    service in the State or outside the State in any capacity full-time/part-time other than
    the above.
    Contd. on page 3
    ::3::

    3) I have drawn total emoluments from this college as under (Please fill the data of last
    academic session) :-
    Amount Received TDS

    April, 20__
    May, 20__
    June, 20__
    July, 20__
    August, 20__
    September, 20__
    October, 20__
    November, 20__
    December, 20__
    January, 20__
    February, 20__
    March, 20__
    (Copy of my form 16 (TDS certificate) for the last financial year is attached)
    P.A.N. : Circle :
    Declaration
    1. I have not worked at any other pharmacy college/institution or presented myself at any
    inspection during my employment in this college.
    2. It is declared that each statement and/or contents of this declaration made by the
    undersigned are absolutely true and correct. In the event of any statement made in this
    declaration subsequently turning out to be incorrect or false the undersigned has
    understood and accepted that such misdeclaration in respect to any content of this
    declaration shall also be treated as a gross misconduct thereby rendering the
    undersigned liable for necessary disciplinary action (including removal of his name
    from Register of Registered Pharmacists).

    Signature of the Employee:


    Date : Place:
    Endorsement
    This endorsement is the certification that the undersigned has satisfied himself/herself
    about the correctness and veracity of each content of this declaration and endorses the
    abovementioned declaration as true and correct. In the event of this declaration
    turning out to be either incorrect or any part of this declaration subsequently turning
    out to be incorrect or false it is understood and accepted that the undersigned shall also
    be equally responsible besides the declarant himself/herself for any such
    misdeclaration or misstatement.

    Countersigned by the Director/Dean/


    Principal in respect of Teaching Staff

    Date : Place :

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