Homoeopathic Medicine Board

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:: Online Application Form for Pharmacist Registration ::

Enclosures for Registration

1.	DHP Diploma Certificate
2.	Domicile Certificate
3.	Two Character Certificate original obtained by two different Gazetted officer working in U.P. Govt. service with seal & date, known time & full address.
4.	Attached Demand Draft of Amount Rs. 2500/- in favour of “Homoeopathic Medicine Board, U.P. Lucknow”.

Enter Registration No and Provisional No for Search :-
Registration No.	:
Provisional No.	:
Note:- Both Field are Mandatory for Search
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Name*

नाम*

Address*
(To be Registered)

District	:	District

Pincode

पता*

जनपद	:	Hindi District

Date of Birth*
(Age between 20 to 99 Years)

Gender*

Male

Female

E-mail*

Email Id

Home Address*

Enter Home Address

District	:

Pincode

गृह निवास का पता*

Enter Home Address

जनपद	:

Father/Husband Name*

Enter Father Name

Relation*

Father

Husband

Select Relation

पिता/पति का नाम*

Enter Father Name

Mother's Name*

Enter Mother Name

माता का नाम*

Enter Mother Name

Name of Board*

Enter University Name

General Qualifications*

Enter General Qualification

Passing Year

Homoeopathic Qualifications(DHP)*

Enter DHP Qualification

DHP Passing Year*

Enter DHP Passing Year

Enrollment No.*

Roll No.*

Mobile No.

Land Line No.

Alternet E-Mail

Amount

DD No.

DD Date

Bank Name

Internship From Date

Required!!!

Internship To Date

Required!!!

Provide the following detail of two diffrent gazetted officers of U.P. from whom character certificates are attached

	First Person	Second Person
Name*	Enter Name
Designation*	Enter Designation
Office Address*	Enter Office Address
Phone No.(More than one phone no Separate by ';')*

I do hereby solemnly affirm that the information furnished above is true to the best of my knowledge. Further I promise to abide by the Rules and Regulations of the BOARD OF HOMOEOPATHIC MEDICINE, UTTAR PRADESH, LUCKNOW, as amended and promulgated from time to time. I pray that I may be registered as a HOMOEOPATHIC PHARMACIST under the selection of couses of study approved by U.P Goverment vide G.O no. 300/71-4-2010-92/96 datetd 5 Feb 2010 Uttar Pradesh Homoeopathic Medicine Act. 1951 (U.P. Act. No. VIII of 1952), as amended from time to time.

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I Agree