FILL OUT THE CLEARANCE FORM BELOW Zone*PCN Registration Number*Full Name*Street Address 1Street Address 2Postcode / ZipPhone Number (Office)*Phone Number (Whatsapp)Email*Physical school attended with year of graduation*Any other qualificationPharmaceutical premises information – State the name and address of premises you practiced in 2023*State the name and address of premises where you would practice in 2024*Are you the pharmacist director? If yes, state the % of equity you own in the companyDo you have the original pharmacy emblem? If yes, state the pharmacy emblem numberPharmacist & premises licenses and form CAC 2 & 7 showing number of shares held by the director – optionalAdditional documents 1Additional documents 2If the information given above is correct and you understand that if at any time such information is found to be untrue, a disciplinary action will be taken against you as the association may deem appropriate. Type YES to confirm*Upload Proof of Payment: N20,410 to Zenith Bank, 1011986062, Association of Community Pharmacists of Nigeria*Zonal coordinator’s name*SUBMIT Error occured. Please confirm your data and submit again:
