If you have not already provided the information, please complete the relevant fitness form and submit it with your application. 1.4 Relevant fee I/we include the relevant fee for this application. 2 Address of the current premises Were these premises included in a pharmaceutical list as a result of an application to which Regulation 13(1)(a) of the NHS (Pharmaceutical Services) Regulations 2005, as amended, applied (approved retail areas)? (If yes, please complete section 7.1 below) Yes No Were these premises included in a pharmaceutical list as a result of an application to which Regulation 13(1)(c) of the NHS (Pharmaceutical Services) Regulations 2005, as amended, applied (one stop primary care centre)? (If yes, please complete section 7.2 below) Yes No Did you relocate to these premises within the last twelve months? (If yes, please complete section 7.3 below) Yes No 3 Address of the premises to which you are applying to relocate premises are currently in my/our possession* Yes No * by rental, leasehold or freehold 4 Opening hours 4.1 Proposed core opening hours
If you have not already provided the information, please complete the relevant fitness form and submit it with your application. 1.4 Relevant fee I/we include the relevant fee for this application. 2 Address of the current premises Were these premises included in a pharmaceutical list as a result of an application to which Regulation 13(1)(a) of the NHS (Pharmaceutical Services) Regulations 2005, as amended, applied (approved retail areas)? (If yes, please complete section 7.1 below) Yes No Were these premises included in a pharmaceutical list as a result of an application to which Regulation 13(1)(c) of the NHS (Pharmaceutical Services) Regulations 2005, as amended, applied (one stop primary care centre)? (If yes, please complete section 7.2 below) Yes No Did you relocate to these premises within the last twelve months? (If yes, please complete section 7.3 below) Yes No 3 Address of the premises to which you are applying to relocate premises are currently in my/our possession* Yes No * by rental, leasehold or freehold 4 Opening hours 4.1 Proposed core opening hours
10-annex-2b-jul16.docx