Pharmacy and Poisons (Forms and Fees) Order (Cap. 53)

20 CAP. 53 Pharmacy and Poisons This e-version of the text is not authoritative for use in court. LAWS OF ST. HELENA PHARMACY AND POISONS (FORMS AND FEES) ORDER – SECTION 13 (Legal Notice 2 of 1937 and Ord. 2 of 1967) Short title 1. This Order may be cited as the Pharmacy and Poisons (Forms and Fees) Order in Council. Forms and fees 2. The forms for the purposes of the Pharmacy and Poisons Ordinance, and the fees payable, shall be as follows— FORM 1 (Section 5(1)) FORM OF APPLICATION FOR A LICENCE TO CARRY ON THE BUSINESS OF A PHARMACIST I, A.B., of ...................………..., hereby apply in accordance with the provisions of Section 3(1)(b) of the Pharmacy and Poisons Ordinance for a licence to carry on the business of a Pharmacist at ......…............... in St. Helena. Date ....................... Signed ....................... FORM 2 (Section 3(2)) FORM OF LICENCE TO CARRY ON THE BUSINESS OF A PHARMACIST A.B., of ....…………………................, is hereby authorised in accordance with the provisions of the Pharmacy and Poisons Ordinance to carry on the business of a Pharmacist at .....………………................ in St. Helena. Date ....................... Senior Medical Officer 3 . 3 Gazette Notice No. 63 of 1 July 2011: Senior Medical Officer/Clinical Director Pharmacy and Poisons CAP. 53 21 This e-version of the text is not authoritative for use in court. LAWS OF ST. HELENA FORM 3 (Section 8(2)(b)) FORM OF POISONS BOOK TO BE KEPT BY AUTHORISED SELLERS OF POISONS POISONS BOOK Date of Sale. Name and Quantity of Poison supplied. Purchaser‘s Purpose for which stated to be required. Date of certi ficate (if any). Name and address of person giving certi ficate (if any). Signature of purchaser or, where a signed order is permitted by the Poisons Rules, the date of the signed order. Name. Address. Business, trade or occupa tion. FORM 4 (Section 11(1)) APPLICATION TO SELL POISONS IN PART B OF THE POISONS LIST I, A.B., of ..............…………......, do hereby apply to be authorised to sell poisons included in Poisons List on my premises at ...........….......... in St. Helena. Date ....................... Signature ....................... 22 CAP. 53 Pharmacy and Poisons This e-version of the text is not authoritative for use in court. LAWS OF ST. HELENA FORM 5 (Section 11(2)) REGISTER OF PERSONS PERMITTED TO SELL POISONS INCLUDED IN PART B OF THE POISONS LIST Serial. Name in full. Date of Entry. Descriptions of premises. Remarks. FORM 6 (Section 8(2)(a)(i)) CERTIFICATE FOR USE WHEN PURCHASER IS NOT KNOWN TO THE SELLER For the purposes of Section 8(2)(a)(i) of the Pharmacy and Poisons Ordinance, I, the undersigned, a householder occupying*...…….……............... hereby certify from my knowledge of†.................……..…...., of*......…….……….............., that he is a person to whom‡ may properly be supplied. I further certify that§..........………………….…….......... is the signature of the said† ………………………. . Signature of householder giving certificate. Date……………………. * Insert address † Insert name of intending purchaser ‡ Insert name of poison § Intending purchaser to sign his name here Pharmacy and Poisons CAP. 53 23 This e-version of the text is not authoritative for use in court. LAWS OF ST. HELENA LICENCE FEES PAYABLE (Sections 5 and 11(1)) 1. Licence to carry on the business of a Pharmacist or to practice pharmacy ........................................................................................................................................... £1 2. For the renewal thereof yearly .......................................................................................................... £1 3. Entry of name in the list of persons authorised to sell drugs included in Part B of the Poisons List ............................................................................................................. £1 4. For retention of the name on the Poisons List in any subsequent year ............................................. £1