Kerala State
Pharmacy Council

A STATUTORY BODY CONSTITUTED UNDER SECTION 19 OF
PHARMACY ACT 1948 (CENTRAL ACT)

Registration

Candidates are advised to go through the instructions carefully before filling up the online application form. Incomplete applications will not be considered for registration.
Name *
(Same as in the SSLC Certificate)
Father's Name *
Place of Birth *
Date of Birth *
 
Blood Group *
Address*
Pincode *
State *
District *
Nationality *
Phone Number (with STD code)
Mobile Number *
Email Id *
ID Proof *
Upload your Colour Photo * [Width:150px Height:200px Max Size:30Kb
Allowed Extension: jpg,jpeg]
Upload your Signature * [Width:150px Height:100px Max Size:30Kb
Allowed Extension: jpg,jpeg,png]
 Whether transfer from other state?
Course Period
Training State   Kerala     Other State
Name of Training institution
Training Period
     
Details of the Trainer
Amount * Payment Mode * Payment Through*
  I hereby agree that the amount of Rs. 1000/- (is for 10 years) for Voluntary Non-refundable deposit for renewal fee is also included in the amount of Rs. 2600/- I paid in favour of the Register, Kerala State Pharmacy Council, Thiruvananthapuram-35. In further, if due to some reasons this amount become inadequate to cover my renewal fee, I shall remit such additional amount as you may deem fit under section 34(1) of the Pharmacy Act 1948.