AFFIDAVIT

I .. s/o sh. aged . r/o h.no. teh. Distt. , do hereby solemnly affirm & declare as under :That I have never been convicted by any court in India under Drugs and Cosmetics Act 1940. And Rules 1945 Framed there under. That I am applying for grant of new whole sale Drug Licence in name of M/s situated at shop No Teh. .. Distt That I am sole proprietor of above said firm and I shall be overall incharge and responsible person to my said firm for its day to day conduct and control of business. That I had never been a propnetor or an active or sleeping partner of any such firm whose whole sale/retail sale/manufacturing drugs licence had ever been cancelled by licecsing authority for any reason whatsoever. That the sale Premises of my said firm is property of its actual owner Sh. S/o Sh. . R/o H. No. Teh. Distt. Who himself directly rented the same to me vide rent receipt date .. for the purpose of whole sale shop only and the said premises is under my legal possession/ whole sale as a tenant. OR That the sale premises of my above said firm is my own property. 6. That the whole sale, supply etc. of drugs at my firm will be dome by .. S/o D/o W/o Sh. . R/o H. No. . has been engaged/ employed by me w.e.f as a whole time employee on salary basis of Rs. p.m. who is Regd. Pharmacist dt. which is mewed up to date? 7. That I will pay conveyance allowance for the distance. 8. That I will opt and want to keep the records of retail sale of drugs in the memo/bills/invoice of my said firm which shall be maintained in legible manner

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9. That I have installed a refrigerator, which is in working condition for cold storage drugs in my said premises and maintain the same till currency of licence 10.That I have provided wooden racks/steel racks for the storage of drugs in my above said firm. 11.That the sale premises of my said firm will not be used/utilized for any other purpose except for business of those categories of drugs which will include in the licence applied for by me or granted to me at my said firm . 12.That I shall comply with provisions rules, regulations and conditions of the Drugs and Cosmetics Act 1940, and Rules 1945 framed there under for the time being in force we are amended from time to time under the said act and rules. 13.That I shall obtain new Drug Licences before changing in constitution or premises take place at my firm and shall inform the Drugs Authorities if any alteration take place at my firm. 14.That in case I close my firm I will give written information along with list of drugs lying at my firm unsaid . Deponent: Verification: I, the above said name do hereby solemnly and declare that whatever is stated above is true and correct to the best of my knowledge and nothing has been kept concealed therein.

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Deponent