2025 CLEARANCE FORM – NEW REGISTRATION

FILL OUT THE CLEARANCE FORM BELOW

Zone*

PCN Registration Number*

Full Name*

Street Address 1

Street Address 2

Postcode / Zip

Phone Number (Office)*

Phone Number (Whatsapp)

Email*

Physical school attended with year of graduation*

Any other qualification

Pharmaceutical premises information – State the name and address of premises you practiced in 2024*

State the name and address of premises where you would practice in 2025*

Are you the pharmacist director? If yes, state the % of equity you own in the company

Do you have the original pharmacy emblem? If yes, state the pharmacy emblem number

Pharmacist & premises licenses and form CAC 2 & 7 showing number of shares held by the director*

Additional documents 1

Additional documents 2

Additional documents 3

If 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*

Error occured. Please confirm your data and submit again:

Association of Community Pharmacists of Nigeria, Eti Osa. Empowering pharmacists, protecting the people.

2025 CLEARANCE FORM – NEW REGISTRATION

FILL OUT THE CLEARANCE FORM BELOW

Quick Links

Menu

Gallery