Good Standing Certificate Request – Pharmacy Council of Mauritius

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Status ( Mr. / Miss/ Mrs.)

Given Name

Surname

Pharmacy Council Registration Number

Pharmacy Board Registration Number if applicable

Date of Registration as Pharmacist (Kindly give maximum information available)

Have you previously been convicted or cautioned for a criminal offence in Mauritius? I hereby certify that i have not been convicted of any crime and I am sending a copy of my morality certificate to the Registrar of the Pharmacy Council by email and i will bring the original to him/her if need be.

I hereby certify that i have not been convicted of any crime and I am sending a copy of my morality certificate to the Registrar of the Pharmacy Council by email and i will bring the original to him/her if need be.

National Identity Card Number

Contact Information ( Mobile Prefereably)

Address (Physical Home address):

Email of the applicant

Qualification ( Have you completed Bachelor in Pharmacy, Doctor in Pharmacy or others)

Place and Country of Qualification(s)

Do you currently have any problems with your physical or mental health that may impair your ability to practise safely and effectively or which otherwise impairs your ability to carry out your duties in a safe and effective manner?

Yes, I am fit to work as pharmacist
No, I am unfit.

Email of the Institutuion/Body that the certificate needs to be email to

1. The information I have provided for this application for a certificate of current professional status and fitness to practice history is complete true and accurate. 2. I am aware that I must notify the registrar of any changes to my name, home address or other contact details within one month starting on the day on which the change occurred. 3. I am aware that I must notify the registrar if there is any change in the circumstances relating to the fitness to practice declaration that I have made above within seven days, starting on the day on which the event occurred. 4. I understand that if I am found to have given false or misleading information in connection with this application for a GSC, this may be treated as misconduct, which may result in my removal from the register.

Yes, I undretand the above statement