1. Address of premises HH..

Transcription

1 FORM 15 [reg. 24B(a)] PHARMACYANPO~ONS0RmANCE (CHAPTER 138) APPLICATION FOR REGISTRATION OF PREMISES UNER SECTION 13 We of...~ (Name ofbusiness)... (Address ofbusiness) wish to apply for the registration under section 13 of the Pharmacy and Poisons Ordinance of the premises as set out in paragraph 1 of this application to conduct the retail sale of poisons at such premises. 1. Address of premises HH.. 2. Name of business at the premises 3. Business Registration No. 4. Telephone No. ofthe premises 5. Name of registered pharmacist in whose presence or under whose supervision the retail sale of poisons is conducted under section 11 (1) of the Ordinance In support of this application, we submit a copy of the certificate of registration of the pharmacist named in paragraph 5. Signature Full name of signatory Signed on behalf of.. (Name ofbusiness) ate H2013 (Rev 11/05)

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3 EPARTMENT OF HEALTH PHARMACEUTICAL SERVICE INSPECTION AN LICENSING SECTION 382 Nam Cheong Street, 3/F., Public Health Laboratory Centre, Kowloon. Tel Fax: A CHECKLIST Application for Registration of Premises of an Authorized Seller of Poisons Please submit this checklist with the following documents. question, please provide a written explanation. If you have answered "No" to any Have you submitted (1) A completed application form? (2) Copy of Business Registration Certificate? (3) (a) For limited companies : (i) Copy of Certificate of Incorporation and (ii) Copy of irectors' List (e.g. "Form ARl" from Companies Registry or for newly formed limited companies, photocopy of a full set of"form NCI" or "Form NClG")? (b) For companies run by sole proprietors : Copy of"form l(a)" from the Business Registration Office? OR OR (c) For companies run by partners: Copy of"form l(c)" from the Business Registration Office1 (4) A list including name(s) in English and Chinese, Hong Kong Identity Card number(s) and posts of sole proprietor/ partners/ directors and staff? (5) A signed declaration of each owner (i.e. sole proprietor or partner) or director, and each staff member indicating whether he/she has been an owner, a director or an employee of other trader(s) of western medicines (i.e. importer/exporter, retailer, wholesaler or manufacturer, regardless whether the trader is still in business)? [If yes, please list out the relevant information, including the English name(s) of the trader(s) and the period involved] (6) Statement of qualifications and relevant experience of sole proprietor/ partners/ directors and all staff members? (PS 02/20 I0)

4 Have you submitted Yes No (7) Testimonials from previous employer(s) certifying the above relevant experience? (8) Copy of the Certificate of Registration and Practising Certificate of the registered pharmacist? (9) Floor plan of ispensary? (10) Floor plan ofispensing Room? (PS 02/20 I 0)

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7 Pharmacy and Poisons Ordinance (Cap. 138) Guidelines for Application for Registration of Premises under Section 13 A company which wishes to conduct the retail sale of any poison must first obtain a Certificate of Registration of Premises under Section 13 of the Pharmacy and Poisons Ordinance. 2. Application forms for the above licence are available, free of charge, by downloading from the web site or in person during the following hours from: epartment of Health, Monday to Friday Pharmaceutical Service, 9:00 a.m. to 1 :00 p.m. Inspection and Licensing Section, 2:00p.m. to 5:45p.m. 382 Nam Cheong Street, (up to 6:00p.m. on Monday) 3/F., Public Health Laboratory Centre, (Closed on Saturdays, Kowloon. Sundays & Public Holidays) Tel Fax: The completed application form together with the relevant documents indicated in the attached checklist should be submitted by post, by fax ( ), by digitally signed certified by Hongkong Post Certification Authority (pharmgeneral@dh.gov.hk) or in person to the above address. In case electronic documents are being used for the application, please refer to web site : and call or for details. 4. An interview will be arranged with the person in charge and pharmacist of the company. Questions based on the relevant legislations and "Code of Practice for Authorized Seller of Poisons" regarding the proper running of a business conducting the retail sale of poisons will be raised during the interview. Upon a successful interview, an inspection by a pharmacist inspector will be conducted at the company's premises. The application will be considered by the Pharmacy and Poisons Board. If approved, a Certificate ofregistration of Premises under Section 13 will be issued. 5. Payment of prescribed fee HK$1,000 will be required when the Certificate of Registration of Premises under Section 13 is ready for collection. Notification of payment will be sent by mail. 6. The performance pledge of the epartment of Health is that applications will be approved within two months. (PS 08/2007)

8 7. These notes are only a general guide and must not be treated as a complete or authoritative statement of the law on any particular case. Copies of the Pharmacy and Poisons Ordinance and its subsidiary legislation may be purchased by calling the Publications Sales Section of Information Services epartment at or by at puborder@isd.gov.hk. Contents of the relevant legislation may also be found at the epartment of Justice's website Copies of the "Code of Practice for Authorized Seller of Poisons" can be obtained in person during office hours, free of charge, from the above mentioned address of the Inspection and Licensing Section of the Pharmaceutical Service or from the Pharmacy and Poisons Board at the following address: Pharmacy and Poisons Board, 182 Queen's Road East, 1/F., Shun Feng International Centre Wanchai, Hong Kong. Tel.: Fax: (PS 08/2007)

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