The National Drug Policy and Authority (Certificate of Suitability of Premises) Regulations, S.I 206-4 are revoked.
Application for a Certificate of Suitability of Premises for Premises for Manufacturing Drugs.
National Drug Policy and Authority Act, Cap 206.
Full names of applicant ____________________________________________ P. O. Box No. __________ Tel. ______________ Fax _______________email Physical address of premises for which certificate is applied for ____________ County______________________________ Sub county___________________________
If applying as representative of the applicant indicate: Name of representative ____________________________________________ Physical address of registered office __________________________________ P.O. Box No. __________ Tel. __________ Fax ___________Email_________ Plot No___ Street Name____________
The form of the drug to be manufactured on the premises (tick as approppriate)- Tablets _____ Capsules _____ Antibiotics _____ Injections (vials) _____ Injections (ampoules) _____ Injections (I.V. fluids) _____ Other sterile products ______________________________ syrup/mixtures _______________________________________ creams/ointments/loti
Others (specify) ________________________________________________
I certify that the above information is correct.
_______________________________ __________________________ Signature of applicant Date
Application for a Certificate of Suitability of Premises for a Wholesale Pharmacy.
National Drug Policy and Authority Act, Cap 206.
Full names of applicant ____________________________________________ P. O. Box No. __________ Tel. ______________ Fax _______________email Physical address of premises for which certificate is applied for ____________ County______________________________ Sub county___________________________
If applying as representative of the applicant indicate: Name of representative _________________________ Physical address of registered office ________________________________ P.O. Box No. __________ Tel. __________ Fax __________Email_________ Plot No_______ Street Name______________
Name and approximate distance of nearest wholesale pharmacy to the premises for which certificate is applied for ___________________________________
I certify that the above information is correct.
____________________________ _____________________ Signature of applicant Date
Application for Certificate of Suitability of Premises for a Retail Pharmacy.
National Drug Policy and Authority Act, |Cap 206.
Full names of applicant _________________________________________ P. O. Box No. _________ Tel. ______________ Fax _______________email Physical address of premises for which certificate is applied for __________ County______________________________ Sub county___________________________
If applying as representative of the applicant indicate: Name of representative _________________________ Physical address of registered office ________________________________ P.O. Box No. __________ Tel. ________ Fax _____________Email________ Plot No___ Street Name______________
Name and approximate distance of nearest retail pharmacy to the premises applied for __________________________________________________ Purposes for which premises are to be licensed (tick proposed activities)-