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Intern Pharmacist Registration Form

Mwombaji atakayewasilisha maombi bila kukidhi vigezo, atahesabika amefanya udanganyifu na hatua stahiki zitachukuliwa dhidi yake.

APPLICATION FOR PROVISIONAL REGISTRATION AS AN INTERN PHARMACIST

(Section 18(1) and (2) of the Pharmacy Act. Cap 311).

Required fields are marked with*.

Applicants are reminded to register their names as they appear in Ordinary Certificate of Secondary Education (CSEE) and Advanced Certificate of Secondary Education (ACSE).

PART I: (To be completed by the applicant)

*First Name

Middle Name

*Last Name

Sex*

*Mobile Phone (Tafadhari andika nama yoyote isipokuwa namba ya halotel)

*Email

Date Of Birth*

*National ID Number (NIDA No.)

*Postal Address

*Region

*Physical Address

*Nationality (Awarding University/College)

*Awarding University/College

*Year of Graduation

*Qualification

*Entry Qualification Used to Join Bachelor of Pharmacy or any Equivalent