| 1 | 1 | MEDICINES AND CONSUMABLES | | | |
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| 2 | 1.01 | Application form for registration to include name of proprietor/partners (Copy of valid partnership deed duly notarized to be attached):- | item1 | 27500 | NO |
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| 3 | 1.02 | (a) Name of the proprietors | item2 | 18900 | NO |
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| 4 | 1.03 | (b) Name of Firm | item3 | 18000 | NO |
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| 5 | 1.04 | (c) Address (Attested photocopy of Electricity/Telephone Bill as proof) | item4 | 16000 | NO |
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| 6 | 1.05 | (d) Shop License No & Validity | item5 | 16000 | SACHET |
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| 7 | 1.06 | (e) Telephone No. (with STD Code) | item6 | 15200 | NO |
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| 8 | 1.07 | (f) Fax | item7 | 15000 | BOTT |
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| 9 | 1.08 | (g) E-mail ID | item8 | 14600 | NO |
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| 10 | 1.09 | Drug License No and Validity | item9 | 10600 | NO |
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| 11 | 1.1 | TAN No (Proof to be attached) | item10 | 10000 | NO |
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| 12 | 1.11 | GST No and Registration Certificate (attach attested photocopy) | item11 | 10000 | NO |
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| 13 | 1.12 | GST Clearance Certificate | item12 | 9600 | NO |
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| 14 | 1.13 | No Objection Certificate from local Excise & Taxation dept(Other than Punjab) | item13 | 9000 | NO |
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| 15 | 1.14 | PAN card of the Firm (attach attested photocopy). | item14 | 9000 | NO |
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| 16 | 1.15 | Shop License Certificate (attach attested photocopy). | item15 | 9000 | NO |
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| 17 | 1.16 | License for manufacturing of Medicines/Dental Items & Med Gases | item16 | 8000 | NO |
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| 18 | 1.17 | License Fee Certificate from Municipal Corporation (attach attested photocopy). | item17 | 7500 | NO |
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| 19 | 1.18 | Blue Print/Map of shop duly certified by Municipal Corporation/Local Auth | item18 | 7500 | NO |
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| 20 | 1.19 | Three photos of premises | item19 | 7200 | NO |
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| 21 | 1.2 | Bank A/c No, Bankers with Branch and address, alongwith ECS Mandate form attested by firm’s bankers (cancelled cheque to be enclosed). | item20 | 7000 | NO |
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| 22 | 1.21 | Latest Income Tax clearance certificate (attach attested photocopy) | item21 | 6800 | NO |
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| 23 | 1.22 | Income tax Returns for the last three years (attach attested photocopy). | item22 | 6500 | NO |
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| 24 | 1.23 | Annual Turnover certificate from CA for last three years (Minimum 50 Lakhs) (attach attested photocopy). | item23 | 6300 | NO |
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| 25 | 1.24 | Surety Bond of terms and conditions on Rs. 100/- non judicial stamp paper duly notarized in firm’s local jurisdiction. | item24 | 6000 | NO |
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| 26 | 1.25 | Certificate for adequate storage facility on Firm’s letter head duly notarized. | item25 | 6000 | NO |
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| 27 | 1.26 | Self certification that the firm is not black listed at any hospital/institute. | item26 | 6000 | NO |
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| 28 | 1.27 | Performance certificate from other Govt Agencies | item27 | 6000 | NO |
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| 29 | 1.28 | Certificate of Sister Concern | item28 | 6000 | NO |
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| 30 | 1.29 | Certificate of undertaking of supply at short notice | item29 | 6000 | NO |
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| 31 | 1.3 | For Distribution/Dealers: Manufacturer’s Agency Agreement/ Notarized declaration and duration of validity. | item30 | 5700 | NO |
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| 32 | 1.31 | For Manufacturing firms/OEM: | item31 | 5200 | NO |
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| 33 | 1.32 | (a) Manufacturing Licence No issued by Drug Licensing auth (attach attested photocopy). | item32 | 5000 | NO |
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| 34 | 1.33 | (b) DGQA Registration / GMP certificate issued by State/Central authority / Certificate of original inventor of molecule. | item33 | 5000 | NO |
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| 35 | 1.34 | (c) DGAFMS/DGQA Registration, if any (Proof to be attached). | item34 | 5000 | NO |
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| 36 | 1.35 | (d) RC Holder with DGAFMS if any (Proof to be attached). | item35 | 4980 | NO |
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| 37 | 1.36 | (e) If the firm is on panel for supplying Medical stores to any Govt agency (Proof to be attached) | item36 | 4740 | NO |
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| 38 | 1.37 | (f) Self Certification regarding quality assurance protocol followed in manufacturing items, as applicable. | item37 | 4700 | NO |
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| 39 | 1.38 | (g) ISO/BIS/CE Certificate as applicable (Attested photocopy to attached). | item38 | 4360 | NO |
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| 40 | 1.39 | Applied for registration for supply of | item39 | 4200 | NO |
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| 41 | 1.4 | Medicines | item40 | 4200 | NO |
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| 42 | 1.41 | Surgical consumables | item41 | 4200 | NO |
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| 43 | 1.42 | Lab Reagents | item42 | 4200 | NO |
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| 44 | 1.43 | Radiology | item43 | 4000 | NO |
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| 45 | 1.44 | Dental Consumables | item44 | 3750 | NO |
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| 46 | 1.45 | Med Gases | item45 | 3600 | NO |
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| 47 | 1.46 | Other specify | item46 | 3600 | NO |
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