Registration Process
Registration Process
Registration Process
From
M.Pharm
(Ph.D.)/others
Present Designation :
Department :
College :
City :
Contd. on page 2
::2::
Permanent Residential
Address of employee : _
E-mail address :
Reader/
Assistant
Professor
Professor
Principal
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).
Date : Place :