FORM 20
[See rule 61(1)]
[LICENCE TO SELL, STOCK OR EXHIBIT OR OFFER FOR SALE, OR DISTRIBUTE] DRUGS BY
RETAIL OTHER THAN THOSE SPECIFIED IN [SCHEDULES C, C(1) AND X]
DR. D JAYAKUMAR
1. DR. D JAYAKUMAR (and 2 others as per partnership deed dated 26/02/2021, TC 13/1622/1 grace, kalakaumudi road,
thiruvananthapuram medical college, thiruvananthapuram-695011)
PARTNER(s) of EXCEL GASTRO CARE
is hereby licensed to sell, stock or exhibit (or offer) for sale, or distribute by retail drugs other than those
specified in [Schedules C, C (1) and X] of the Drugs and Cosmetics Rules 1945, *and to operate a pharmacy on the
premises situated at
T.C.42/1530, GROUND FLOOR, CHENGALLUR,
POOJAPPURA-P.O, , THIRUVANANTHAPURAM
Tal : THIRUVANANTHAPURAM ( THIRUVANANTHAPURAM )
Pin : 695012 Phone: Mobile: 9447617998
subject to the conditions specified below and to the provisions of the Drugs and Cosmetics Act, 1940 and the Rules
thereunder
2.The licence shall be in force from : 18.Jun-2022 to 17.Jun-2027 Area : 11.08 SqMts
3.Name (s) of R.Ps & Competent Person(s) in charge (C.P NOT authorized to SIGN in Retailer Bills):
RP-44940 - REMYA B
4.Categories of Drugs : Drugs covered under the license
5.Specific Condition :PHARMACY NOT PERMITTED. OPTION EXERCISED UNDER 65(3) (1)and 65(4)
(1)of DRUGS COSMETICS RULES 1945
e-Signed on 18/06/2022 15:20:33
TPAV # X99B77UP1R
REMYA B (R.P)
SAJEEV KUMAR M S
Licensing Authority
Licence no: KL-TVM-167568
Drugs Control Department
:On: 18.Jun-2022
Conditions of Licence
1. This licence shall be displayed in a prominent place in a part of the premises open to the public.
2. The licence unless sooner suspended or cancelled, shall remain valid perpetually. However, the
compliance with the conditions of licence and the provisions of the Drugs and Cosmetics Act,
1940 (23 of 1940) and the Drugs and Cosmetics Rules, 1945 shall be assessed not less than
once in three years or as needed as per risk based approach.
3. The licensee shall report to the Licensing Authority any change in the qualified staff in charge within one month
of such change.
4. No drug shall be sold unless such drug is purchased under cash or credit memo from a duly licensed dealer or a
duly licensed manufacturer
5. The licensee shall inform the Licensing Authority in writing in the event of any change in the constitution of the
firm operating under the licence. Where any change in the constitution of the firm takes place, the current licence
shall be deemed to be valid for a maximum period of three months from the date on which the change takes
place unless, in the meantime, a fresh licence has been taken from the Licensing Authority in the name of the firm
with the changed constitution.
6. The Licensee shall not Claim any equities or rights in the property under reference on strength
of this licence.
Note: Prev Dtls - 46541~EXCEL GASTRO CARE~DR. D JAYAKUMAR~T.C.42/1530, GROUND FLOOR,
This License/Certificate is eSIGNED. Physical Signature is NOT Required
District Dept File No Type:Fresh License Form [20] Licence No Old LIC No
THIRUVANANTHAPURAM 46541 FRE-452702-07/06/2022 KL-TVM-167568 -
For online Third Party Approval Verification; Go to xlnindia.gov.in & Click TPAV button. 18/06/22
