FORM 21
[See rule 61(2)]
Licence to sell, stock or exhibit (or offer) for sale or distribute drugs, by retail
specified in Schedules C and C (i) [ excluding those specified in Schedule X ]
BALAJI KARBHARI SATPUTE
1. BALAJI KARBHARI SATPUTE
PROPRIETOR of SHRI BALAJI MEDICAL AND GENERAL STORES
is hereby licensed to sell, stock, or exhibit (or offer) for sale or distribute by retail the following categories of drugs specified in
Schedules C and C(1) [ excluding those specified in Sch.X ] to the Drugs and Cosmetics Rules, 1945, and to operate a
pharmacy on the premises situated at
SHOP NO 1, MILKAT NO 300, GROUND FLOOR,
MAIN ROAD, , DAREGAON.
Tal : JALNA ( JALNA )
Pin : 431203 Phone: 9975675795 Mobile: 9975675795
subject to the conditions specified below and to the provisions of the Drugs and Cosmetics Act, 1940 and Rules thereunder.
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.
The licence shall be in force from : 05.Jun-2023 to 04.Jun-2028 ** Area : 12.32 SqMts
3.Name (s) of R.Ps & Competent Person(s) in charge (C.P NOT authorized to SIGN in Retailer Bills):
RP-131726 - BALAJI KARBHARI SATPUTE(DPH,)
4.Categories of drugs : All items of schedule C and C1 drugs,[excluding those specified in Sch. X]
e-Signed on 05/06/2023 13:04:14
TPAV # V9UGXX3GVH
BALAJI KARBHARI SATPUTE (R.P)
VARSHA PRAVIN MAHAJAN
Licence no: MH-JLN-110368 Licensing Authority & Assistant Commissioner
: Food & Drugs Administration, JALANA
On: 05.Jun-2023
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 licensee shall report to the Licensing Authority any change in qualified staff in charge whithin
one month of such change.
3. Omitted.
4. If the licensee wants to sell, stock or exhibit for sale, or distribute, during the currency of the licence,
additional categories of drugs listed in schedules C and C (1) [excluding those specified in Sch.X ] but not
included in this licence, he should apply to the Licensing Authority for the necessary permission. This licence
will be deemed to extend to the categories of drugs in respect of which such permission given. This
permission shall be endorsed on the licence by the Licensing Authority.
5. No drug shall be sold unless such drug is purchased under a cash or credit memo from a duly licensed dealer
or a duly licensed manufacturer.
6. 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 take 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.
** The Licensee shall not Claim any equities or rights in the property under reference on strength of this licence.
**This Licence shall remain valid if licensee deposits a licence retention fee before the expiry of a period of every
succeeding five years from the date of its issue unless, it is suspended or cancelled by Licensing Authority.
Note: Prev Dtls - 226585~SHRI BALAJI MEDICAL AND GENERAL STORES~BALAJI KARBHARI SATPUTE ~GALA NO. 01, H.NO. 217,~MAIN ROAD,
This License/Certificate is eSIGNED. Physical Signature is NOT Required.
District FDA File No Type:Change Premises Form [21] Licence No Old LIC No
JALNA 226585 C.P--1200249-20/05/2023 MH-JLN-110368 -
For online Third Party Approval Verification; Go to fdamfg.maharashtra.gov.in & Click TPAV butto 05/06/23 N I C
