S.L. 94.13 Art. 55Authorisation and object of affixing of seal. FORM REGISTER NUMBER I HEREBY of the principal specified below: REGISTRATION NUMBER

PART IV

En vigueurTexte officiel

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

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

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

(Standing Order 39)

FORM OF REGISTERS

PHARMACY BOARD - MALTA

The .............................. Register

Title to Original Registration Date of Number of Name Address and registration Registration Additional Qualification

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

...................... ...................... ...................... ..................... ......................... SECOND SCHEDULE

(Standing Order 41) FORM OF APPLICATION FOR REGISTRATION

PHARMACY BOARD - MALTA Application for Registration

I apply to be registered under article ............ of the Medical and Kindred Professions Ordinance.

My full name is .......................................................................... (Give full name in capital letters, surname underlined) I was born at ................................ on .........................................

(day, month, year)

My home or permanent address* for entry in the Register is

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

The address* to which my Certificate of Registration should be sent is ..........................................................................................

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

Description of qualifications (s) ..................................................

Date on which conferred .............................................................

University or Body by which granted ..........................................

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

I submit in support of my application the licence granted to me by the

Minister responsible for the Department of Health to practise

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

Signature of applicant .................................................................

Date of application .....................................................................

*Give these addresses in full. THIRD SCHEDULE

(Standing Order 43) FORM OF CERTIFICATE OF REGISTRATION

PHARMACY BOARD - MALTA CERTIFICATE OF REGISTRATION IN THE .......... REGISTER (........................... LIST)

NUMBER ............................. Date ............................. I HEREBY CERTIFY that the following is a true copy of the entry made in the ............................................... List of the .................... Register in respect of the name specified below:

DATE OF REGISTRATION NAME ADDRESS REGISTRATIO QUALIFICATIONS NUMBER N

Seal REGISTRAR PHARMACY BOARD - MALTA FOURTH SCHEDULE

(Standing Order 48) FORM OF CERTIFICATE OF ALTERATION OF REGISTERED NAME PHARMACY BOARD - MALTA

CERTIFICATE OF ALTERATION OF NAME IN THE ........................ REGISTER

NUMBER ............................. Date ............................. I HEREBY CERTIFY that the following name has been altered as indicated in the ............................................... Register

NAME NAME AS DATE OF PREVIOUSLY NOW ADDRESS REGISTRATIO QUALIFICATIONS IN REGISTER REGISTERED N

Seal REGISTRAR PHARMACY BOARD - MALTA FIFTH SCHEDULE

(Standing Order 49 (2)) FORM OF APPLICATION FOR TEMPORARY REGISTRATION PHARMACY BOARD- MALTA

Application for Temporary Registration I apply for temporary registration as a .........................................

in Malta under article ....................................... of the Medical and Kindred Professions Ordinance.

My full name is .......................................................................... My permanent address is ............................................................ I was born at ............................... on .......................................... (day, month, year) My present nationality is ............................................................

Description of qualification(s) .................................................... Date on which conferred ............................................................. University or Body by which conferred .......................................

*never applied before I have *already applied on ..................................

for temporary registration in Malta.

I submit in support of my application the temporary licence granted to me by the Minister responsible for Health to practise

................................................................................................... Signature of applicant ................................................................. Date of application .....................................................................

*Delete whichever is not applicable. SIXTH SCHEDULE

(Standing Order 49(4)) OF CERTIFICATE OF TEMPORARY REGISTRATION

PHARMACY BOARD - MALTA CERTIFICATE OF TEMPORARY REGISTRATION IN THE ..............................

(PRINCIPAL LIST)

............................. Date ............................. CERTIFY that the following is a true copy of the entry in the supplementary part list of the ............................................. Register in respect of the name

PERIOD DATE OF OF VALIDITY NAME ADDRESS QUALIFICATIONS REGISTRATION OF REGISTRATION

Seal REGISTRAR PHARMACY BOARD - MALTA