S.L. 464.12 Art. 55Affixing of seal to all certificates of registration. to Registration Additional body and date) Original Registration in OF AS A Act 13 of the Council and WHICH A AND TITLE* training) E IN YOUR PRACTISE NUMBER ANY FULL- RIGHT TO A. Birth B. C. Police D. E. THE PHA FURTHER MADE OR FROM I DECLARE IS C

(1) The Registrar, or another officer of the Council authorized in writing by the President of the Council, shall be authorized to affix the seal to all certificates of registration and to all formal commissions issued by the Council.

(2) Save as aforesaid, the seal shall be affixed only by order or under the authority of the Council.

(3) Any order for affixing the seal shall state the object of its use and shall be entered in the minutes of the Council. FIRST SCHEDULE A (Regulation 39)

FORM OF REGISTERS PHARMACY COUNCIL - MALTA THE ................................ REGISTER

Original number of Name and Locality Date of First Period of Title Registration in Malta Surname Registration validity and in Malta Qualification/s (awarding

FIRST SCHEDULE B (Regulation 39)

FORM OF TEMPORARY REGISTERS PHARMACY COUNCIL - MALTA THE ......................... REGISTER

number of Name and Locality Date of Period of Title to Registration Malta Surname Temporary validity (awarding body and Registration date) SECOND SCHEDULE A (Regulation 41)

FORM OF APPLICATION FOR REGISTRATION IN THE REGISTER PHARMACISTS

PHARMACY COUNCIL - MALTA APPLICATION FOR REGISTRATION AND LICENCE TO PRACTICE PHARMACIST IN MALTA I wish to apply to be registered under article 17 of the Health Care Professions (Cap. 464) and for a Licence to practice as a Pharmacist under article Health Care Professions Act (Cap. 464).

FULL NAME (please indicate Prof./Dr./Mr./Ms.)*

DATE OF BIRTH* ID No./Passport No.* CITIZENSHIP*

ARE YOU REGISTERED WITH ANOTHER If yes state the COUNCIL (regulating Health Care Professions)? Profession Yes/No (underline appropriate) PERMANENT ADDRESS*

POSTAL ADDRESS (to which correspondence shall be sent)*

TELEPHONE NOS. MOBILE NO. E-MAIL ADDRESS

UNIVERSITY, COLLEGE OR SCHOOL (incl. country) FROM DEGREE OR QUALIFICATION IN PHARMACY WAS OBTAINED

DATE OF CONFERRAL*

DETAILS AND DATES OF ANY PRACTICAL TRAINING (in-service REQUIRED BEFORE YOU WERE ELIGIBLE TO PRACTIS COUNTRY (member state) AND NUMBER OF HOURS PER WEEK*

DATE YOU FIRST REGISTERED AND ACQUIRED THE RIGHT TO AS A PHARMACIST IN YOUR MEMBER STATE, REGISTRATION AND COMPETENT AUTHORITY WITH WHICH YOU ARE REGISTERED**

DETAILS, DATES AND NUMBER OF HOURS PER WEEK OF TIME EXPERIENCE SINCE YOU FIRST ACQUIRED THE PRACTISE AS A PHARMACIST IN YOUR MEMBER STATE

SUPPORTING DOCUMENTS: Certificate* Evidence of Nationality*

Certificate of Good Conduct* Certified True Copy of Degree* Certified True recent passport photo*

RMACY COUNCIL RESERVES THE RIGHT TO REQUEST EVIDENCE OR PROOF OF STATEMENTS OR INFORMATION SUBMITTED IN THIS APPLICATION FORM FROM YOURSELF OR RELEVANT COMPETENT AUTHORITIES. THAT TO MY KNOWLEDGE, THE INFORMATION PROVIDED

.............................................. ......................................

Applicant Date data

Obligatory data for applicants already registered in any other other member may not sign this if you so choose) AUTHORIZE THE COUNCIL TO FORWARD MY ADDRESS AND DETAILS TO THIRD PARTIES WHO WOULD LIKE TO CORRESPOND WITH ME ON MATTERS REGARDING PHARMACY.

.............................................. .............................................. Applicant Date

SECOND SCHEDULE B (Regulation 41) FORM OF APPLICATION FOR TEMPORARY REGISTRATION REGISTER OF PHARMACISTS PHARMACY COUNCIL - MALTA

APPLICATION FOR TEMPORARY REGISTRATION AND TEMPORARY LICENCE TO PRACTICE AS A PHARMACIST IN MALTA

I wish to apply to be temporarily registered under article 17(4) of the Professions Act (Cap. 464) and for a Licence to practice as a Pharmacist article 13 of the Health Care Professions Act (Cap. 464).

FULL NAME (please indicate Prof./Dr./Mr./Ms.)*

DATE OF BIRTH* ID No./Passport No.* CITIZENSHIP*

ARE YOU REGISTERED WITH ANOTHER If yes state the COUNCIL (regulating Health Care Professions)? Profession Yes/No (underline appropriate) PERMANENT ADDRESS*

POSTAL ADDRESS (to which correspondence shall be sent)*

TELEPHONE NOS. MOBILE NO. E-MAIL ADDRESS

UNIVERSITY, COLLEGE OR SCHOOL (incl. country) FROM DEGREE OR QUALIFICATION IN PHARMACY WAS OBTAINED

DETAILS AND DATES OF ANY PRACTICAL TRAINING (in-service REQUIRED BEFORE YOU WERE ELIGIBLE TO PRACTIS COUNTRY (member state) AND NUMBER OF HOURS PER WEEK*

DATE YOU FIRST REGISTERED AND ACQUIRED THE RIGHT TO AS A PHARMACIST IN YOUR MEMBER STATE, REGISTRATION AND COMPETENT AUTHORITY WITH WHICH YOU ARE REGISTERED**

DETAILS, DATES AND NUMBER OF HOURS PER WEEK OF TIME EXPERIENCE SINCE YOU FIRST ACQUIRED THE PRACTISE AS A PHARMACIST IN YOUR MEMBER STATE

SUPPORTING DOCUMENTS:

F. Birth Certificate* Evidence of Nationality* Certificate of Good Conduct*

Evidence of Qualification if you have not yet received such qualification* or Certified True Copy of Degree* Certified True recent passport photo*

RMACY COUNCIL RESERVES THE RIGHT TO REQUEST EVIDENCE OR PROOF OF STATEMENTS OR INFORMATION SUBMITTED IN THIS APPLICATION FORM FROM YOURSELF OR RELEVANT COMPETENT AUTHORITIES. THAT TO MY KNOWLEDGE, THE INFORMATION PROVIDED

.............................................. ......................................

Applicant data

Obligatory data for applicants already registered in any other other member may not sign this if you so choose) AUTHORIZE THE COUNCIL TO FORWARD MY ADDRESS AND DETAILS TO THIRD PARTIES WHO WOULD LIKE TO CORRESPOND WITH ME ON MATTERS REGARDING PHARMACY.

.............................................. .............................................. Applicant Date

APPLICATION FOR REGISTRATION IN THE REGISTER OF PHARMACY TECHNICIANS PHARMACY COUNCIL - MALTA APPLICATION FOR REGISTRATION TO PRACTICE AS A PHARMACY TECHNICIAN IN MALTA I apply to be registered under article 18 of the Health Care Professions 464) to practice as a Pharmacy Technician.

FULL NAME (please indicate Prof./Dr./Mr./Ms.)*

DATE OF BIRTH* ID No./Passport No.* CITIZENSHIP*

ARE YOU REGISTERED WITH ANOTHER If yes state the COUNCIL (regulating Health Care Professions)? Profession Yes/No (underline appropriate) PERMANENT ADDRESS*

POSTAL ADDRESS (to which correspondence shall be sent)*

TELEPHONE NOS. MOBILE NO. E-MAIL ADDRESS

UNIVERSITY, COLLEGE OR SCHOOL (incl. country) FROM QUALIFICATION IN THE PRACTICE OF PHARMACY TECHNICIAN OBTAINED AND TITLE

SUPPORTING DOCUMENTS: L. Birth Certificate*

M. Evidence of Nationality* N. Police Certificate of Good Conduct* O. Certified True Copy of Qualification*

THE PHARMACY COUNCIL RESERVES THE RIGHT T FURTHER EVIDENCE OR PROOF OF STATEMENTS OR INFORMATION MADE OR SUBMITTED IN THIS APPLICATION FORM FROM YOURSELF FROM RELEVANT COMPETENT AUTHORITIES. I DECLARE THAT TO MY KNOWLEDGE, THE INFORMATION IS CORRECT.

.............................................. ......................................

Signature of Applicant

* Obligatory data

** Obligatory data for applicants already registered in any other state

(Optional: you may not sign this if you so choose) AUTHORIZE THE COUNCIL TO FORWARD MY ADDRESS AND DETAILS TO THIRD PARTIES WHO WOULD LIKE TO CORRESPOND WITH ME ON MATTERS REGARDING PHARMACY.

.............................................. .............................................. Applicant Date

APPLICATION FOR TEMPORARY REGISTRATION IN THE REGISTER OF PHARMACY TECHNICIANS

PHARMACY COUNCIL - MALTA APPLICATION FOR TEMPORARY REGISTRATION TO PRACTICE PHARMACY TECHNICIAN IN MALTA I apply to be temporarily registered under article 18 of the Health Care Act (Cap. 464) to practice as a Pharmacy Technician. FULL NAME (please indicate Prof./Dr./Mr./Ms.)*

DATE OF BIRTH* ID No./Passport No.* CITIZENSHIP*

ARE YOU REGISTERED WITH ANOTHER If yes state the COUNCIL (regulating Health Care Professions)? Profession Yes/No (underline appropriate) PERMANENT ADDRESS*

POSTAL ADDRESS (to which correspondence shall be sent)*

TELEPHONE NOS. MOBILE NO. E-MAIL ADDRESS

UNIVERSITY, COLLEGE OR SCHOOL (incl. country) FROM QUALIFICATION IN THE PRACTICE OF PHARMACY TECHNICIAN OBTAINED AND TITLE

SUPPORTING DOCUMENTS: P. Birth Certificate* Q. Evidence of Nationality*

R. Police Certificate of Good Conduct* S. Certified True Copy of Qualification* or evidence of qualification conferred THE PHARMACY COUNCIL RESERVES THE RIGHT T FURTHER EVIDENCE OR PROOF OF STATEMENTS OR INFORMATION MADE OR SUBMITTED IN THIS APPLICATION FORM FROM YOURSELF FROM RELEVANT COMPETENT AUTHORITIES. I DECLARE THAT TO MY KNOWLEDGE, THE INFORMATION IS CORRECT.

.............................................. ...................................... Signature of Applicant

* Obligatory data ** Obligatory data for applicants already registered in any other state (Optional: you may not sign this if you so choose) AUTHORIZE THE COUNCIL TO FORWARD MY ADDRESS AND DETAILS TO THIRD PARTIES WHO WOULD LIKE TO CORRESPOND WITH ME ON MATTERS REGARDING PHARMACY.

.............................................. .............................................. Applicant Date

THIRD SCHEDULE (Regulation 43) FORM OF CERTIFICATE OF REGISTRATION PHARMACY COUNCIL - MALTA

CERTIFICATE OF REGISTRATION IN THE ....................... REGISTER ------------------------

Number: ......................... Date: ....................... I HEREBY CERTIFY that the following is a true copy of the entry ............................ Register in respect of the name specified below Registration number Name Locality Date of Title to Registration Registration Additional (awarding

Seal Pharmacy Council - Malta (name)

REGISTRAR

FOURTH SCHEDULE (Regulation 48) FORM OF CERTIFICATE OF ALTERATION PHARMACY COUNCIL - MALTA

CERTIFICATE OF ALTERATION IN THE .......................... REGISTER ------------------------

......................... Date: ....................... CERTIFY that the following alteration has been made in the ......................... Register in respect of the person below.

entry number Name Locality Date of Title to Registration and Registration Additional Qualification (awarding body and date)

number Name Locality Date of Title to Registration and Registration Additional Qualification (awarding body and date)

Pharmacy Council - Malta (name)

REGISTRAR

SIXTH SCHEDULE

(Regulation 49) FORM OF CERTIFICATE OF TEMPORARY REGISTRATION PHARMACY COUNCIL - MALTA

CERTIFICATE OF TEMPORARY REGISTRATION IN THE ....................... REGISTER

Original number of Name and Locality Date of Period of Title Registration in Malta Surname Temporary validity (awarding Registration

Seal Pharmacy Council - Malta (name) REGISTRAR