(to be filled by all registered pharmacists) PHARMACIST PARTICULARS SHEET1 Personal Data Surname:…………………………………………………………… Date of Birth (dd/mm/yyyy):…………………………………………………………… Sex: M / F Place of birth:………………………………………………………………………………………. Nationality:………………………………………………………………………………………….. Id card number:………………………………………………………………………………….. Registration No.: Registration date: ……………………………………….. ………………………………….. Telephone No.(Res.): Mobile: ………………………………… …………………………………………………… Email address:………………………………………………………………………………………………………………… End-of-secondary school qualifications A Index Subjects passed at "A" A Level Aggregate Year Institution Level No. level at one sitting Grade Points points 1 2 3 Tertiary Education Date of enrolment in Pharmacy School / University or other institution:……………………… Date when applicant passed examinations:……………………………………………………………. Details of qualifications:………………………………………………………………………………………………….. Graduation Name of Period Title Country Date Institution attended Pre-Registration Training
PHARMACIST PARTICULARS SHEET1 (to be filled by all registered pharmacists) Personal Data Surname:…………………………………………………………… Date of Birth (dd/mm/yyyy):…………………………………………………………… Sex: M / F Place of birth:………………………………………………………………………………………. Nationality:………………………………………………………………………………………….. Id card number:………………………………………………………………………………….. Registration No.: ……………………………………….. Registration date: ………………………………….. Telephone No.(Res.): ………………………………… Mobile: …………………………………………………… Email address:………………………………………………………………………………………………………………… End-of-secondary school qualifications Year Index No. Institution Subjects passed at "A" level at one sitting A Level Grade A Level points Aggregate Points 1 2 3 Tertiary Education Date of enrolment in Pharmacy School / University or other institution:……………………… Date when applicant passed examinations:……………………………………………………………. Details of qualifications:………………………………………………………………………………………………….. Title Graduation Date Name of Institution Country Period attended Pre-Registration Training
Particulars-sheet-Ver-8-Nov-2017.docx