KARNATAKA STATE PHARMACY COUNCIL

514/E, I Main, II Stage, Vijayanagar, Bangalore – 560 104

Ph: 080-46729800 (800 to 899 lines); 080-23404000, 23383142
E-mail: kspcreg@gmail.com, Web: www.kspcdic.com

FRESH APPLICATION – KSPC-A

1. General Instructions

a. The applicant should be a Citizen of India and should have completed 18 years of age.

b. Registerable Qualifications - D. Pharm, B. Pharm, Pharm D approved by Pharmacy Council of India

c. Institution / College should have been approved by Pharmacy Council of India at the time of
admission to 1st year D. Pharm, B. Pharm, Pharm D.

2. Fees (Refer Notifications on www.kspcdic.com)

Fee can be directly remitted to the following account by NEFT / Net Banking (Credit & Debit Card)

Payment – 1 (KSPC) Payment – 2 (KPCRPWT) Payment – 3* (Additional

Qualification)

Amount: Rs.3,700.00/- Amount: Rs.4,200/- Amount: Rs.1,000/- per Qualification.

Account Name: “Karnataka Bank Name: State Bank of India
Account Name: “Karnataka State Pharmacy Council Registered
Pharmacy Council" Branch: Vijayanagar II Stage
Pharmacist Welfare Trust "
Account Type: Savings Bank IFSC Code: SBIN0040231
Account Type: Savings Bank
Account No.: 52117060304 Account Name: “Karnataka State
Account No.: 1052500100173701
Bank Name: State Bank of India Pharmacy Council"
Bank Name: Karnataka Bank Limited
Branch: Vijayanagar II Stage Account Type: Savings Bank
Branch: Vijayanagar
IFSC Code: SBIN0040231 Account No.: 52117060304
IFSC Code: KARB0000105

Note:

* - Payment – 3 – Applicable to pharmacists who intend to upgrade their qualification along with the
Registerable Qualification
Payment made by NEFT: The Counter foil of the payment remitted to KSPC account should be
uploaded.
3. Personal details to be filled by the applicant

Sl.No Particulars Details

1. Name of the As per Diploma / Degree Certificate.
Candidate
2. Father's Name As per Diploma / Degree Certificate.
3. Mother Name As per SSLC or 10th marks card / Cumulative Record / Birth Certificate
/ Passport with validity (issued by competent authority).
4. Date of Birth As per SSLC or 10th marks card / Cumulative Record / Birth Certificate
/ Pan Card / Passport with validity (issued by competent authority).
5. E-mail Candidate personal mail ID (for validation and further
communication).
6. Mobile No Candidate mobile number (for validation and further communication).
7. Blood Group Report issued by a pathology laboratory / hospital.
8. Residential Address Refer Sl.No 4 for details
of Karnataka
9. Permanent Address Refer Sl.No 4 for details
 4. Marks Card issued by competent authority - Scan and keep ready the following original
documents before filling the Online application form. The same relevant marks cards to be
submitted for verification to the Council.

A B C
Proof for Date of Birth Address Proof of the Address Proof of the Candidate of Karnataka
(issued by competent Candidate being Permanent (both sides wherever applicable) – any one proof
authority) – any one proof Resident of Karnataka -
(both sides wherever
applicable) – any one proof

➢ SSLC or 10th marks card ➢ Voter ID ➢ Passport with validity

➢ Cumulative Record ➢ Ration Card ➢ Rented house - Rental agreement along with
➢ Birth Certificate ➢ Aadhar Card the Aadhar Card/Voter ID/Passport of the
Owner with Notarization of the area residing.
➢ Pan Card ➢ Driving License
➢ Staying in PG: Letter from PG Warden that you
➢ Passport with validity ➢ Passport with validity are staying in the PG + Warden ID proof
➢ Staying in the hospital hostel: Submit ID
Card and original letter (on the hospital
letterhead) with seal and signature from
hospital / RMO / Superintendent that you are
working in the hospital and staying in the
hospital hostel.
➢ Staying in college hostel: Submit ID Card
and original letter (on the college letterhead)
from the college Principal that you are studying
and staying in the college hostel + Warden ID
Proof.
➢ Staying in the company guest house:
Submit original letter (on the company
letterhead) with seal and signature from
company head that you are working in the
company and staying in the company quarters

5. Marks Card issued by competent authority - Scan (both sides wherever applicable) and keep ready the
following original documents before filling the Online application form (✓ - Documents are mandatory)

Pharm D*
Pharm D*
M.Pharm
B.Pharm
Diploma
SSLC

Ph.D

(PB)
PUC

Practical Training Form

Provisional Certificate
Provisional Certificate

Provisional Certificate

Provisional Certificate
Diploma Certificate

Degree Certificate
Degree Certificate

Degree Certificate

Degree Certificate
Practical Training
I year & II year

III (internship)
VI (internship)
Convocation
Certificate
III year

IV year
II year

II year

II year
I year

I year

I year

III

IV
II

II
V
I

D.Pharm ✓ ✓ ✓ ✓ ✓ ✓ - - - - - - - - - - - - - - - - - - - - - - - -
B.Pharm ✓ ✓ - - - ✓ ✓ ✓ ✓ ✓ ✓ ✓ - - - - - - - - - - - - - - - - - -
B.Pharm ✓ ✓
+D.Phar ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ - - - - - - - - - - - - - - - - - -
m
M.Pharm ✓ ✓ - - - ✓ ✓ ✓ ✓ - ✓ ✓ ✓ ✓ ✓ - - - - - - - - - - - - -
M.Pharm
+B.Phar
m+ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ - ✓ ✓ ✓ ✓ ✓ - - - - - - - - - - - - -
D.Pharm
Ph.D ✓ ✓ - - - ✓ ✓ ✓ ✓ - ✓ ✓ ✓ - ✓ ✓ - - - - - - - - - - - -
Ph.D+
M.Pharm
+B.Phar ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ - ✓ ✓ ✓ - ✓ ✓ - - - - - - - - - - - -
m+D.Pha
rm
PharmD
+ ✓ ✓ ✓ ✓ ✓ - - - - - - - - - - - ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ - - - - -
D.Pharm

PharmD ✓ ✓ - - - - - - - - - - - - - - ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ - - - - -
PharmD
(PB) ✓ ✓ - - - ✓ ✓ ✓ ✓ - ✓ - - - - - - - - - - - - - ✓ ✓ ✓ ✓✓
PharmD
(PB)
+B.Phar
m+ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ - ✓ - - - - - - - - - - - - - ✓ ✓ ✓ ✓✓
D.Pharm

Note: Provisional Degree Certificate (PDC) is valid for a period of one year from the date of issue of PDC.

Practical Training Form / Certificate (upload along with Certificate)

Sl.No. Course Particulars

1. D.Pharm – Training in Medical Stores / Section-I to V (All the sections must be filled and the
Hospital dates must be in chronological order only)

Appendix-E along with licence forms 20, 21, I - College Principal seal, signature, name of the principal with
21C and Registered Pharmacist E-Certificate date.
II – Student signature with date.
III – Medical stores / hospital seal, signature, date and name of
the registered pharmacist with KSPC Reg.No.
IV – Undergone training for ….. (hrs) from …… to ………….. with
date and Medical stores / hospital seal, signature, date and
name of the registered pharmacist with KSPC Reg.No
V - College Principal seal, signature, name of the principal with
date.

2. B.Pharm - Training in Industry / Hospital Undergone training in Industry / Hospital for ….. (hrs) from
……… to ………… Seal and Signature by the HR Manager / Head
Company / Hospital letter head of the Industry or Director/Superintendent from the hospital
and countersigned by the Principal with seal and date.

3. Pharm D / Pharm D (Post Baccalaureate) A certificate of satisfactory completion of training along with
– Internship – Training in Hospital logbook (attendance with signature) from the Director /
Superintendent from the hospital which shall be countersigned
by the Principal or Dean of the Pharmacy College you studied.

Note: Any corrections made should be countersigned by the respective authority.

6. Other documents to upload

Sl.No Particulars Details

a. PCI approval letter (all the sheets) PCI approval letter for the year of admission (YOA) + previous
year + next year along with approved college list.
b. Student Study Certificate Letter from College Click here to download the format of the certificate
(original) http://kspcdic.com/sites/Bonafide%20college%20Letter.pdf
c. Affidavit – Pharmacy Ethics (all the sheets) on On Rs.20/- Non-Judicial Bond Paper (not less than 15 working
Karnataka Stamp Paper only days from the date of Notarization) attested by Notary as per
format. Click here to download
https://kspcdic.com/pdf/affidavits/Pharmacy%20Ethics%20-
%2002-11-2018.pdf
d. Affidavit (all the sheets) - Candidate who has On Rs.20/- Non-Judicial Bond Paper (not less than 15 working
failed to register within 12 months from the days from the date of Notarization) attested by Notary as per
date of Diploma / Degree certificate issued - format. Click here to download the
on Karnataka Stamp Paper only https://kspcdic.com/pdf/affidavits/Form-A%20-
%20those%20who%20have%20failed%20to%20register%20wit
hin%20one%20year%20-%2025-04-2019.pdf

e. Affidavit (all the sheets) - Candidates who On Rs.100/- Non-Judicial Bond Paper (not less than 15 working
have studied BAMS/BUMS/BNYS/BSMS/ BSAM days from the date of Notarization) attested by Notary as per
/Nursing/Physiotherapy/Integrated format. Click here to download the
/B.E/B.Sc/B.Com/any other degree (upload https://kspcdic.com/pdf/affidavits/Affidavit%20for%20candidat
all relevant marks card and certificates es%20who%20have%20studied%20BAMS,%20Pharmacy%20and
along with affidavit) on Karnataka Stamp
 Paper only %20other%20degree%20-%2025-04-2019.pdf
f. Study GAP Affidavit (Other reasons apart On Rs.20/- Non-Judicial Bond Paper (not less than 15 working
from Education) (upload all relevant days from the date of Notarization) attested by Notary as per
marks card and certificates along with format. Click here to download the
affidavit) on Karnataka Stamp Paper only https://kspcdic.com/pdf/affidavits/Affidavit%20for%20Study%2
0GAP%20Certificate%20(apart%20from%20education)_25-04-
2019.pdf
g. Affidavit for Change of Name on Karnataka Affidavit from 1st Class Judicial Magistrate on Rs.20/- Non-
Stamp Paper only Judicial Bond Paper with seal and signature along with Court
Order / Gazette Notification & Paper Advertisement
authenticating change of name.
h. Photo Scan and upload the recent passport size colour photo which
white background only (jpg, jpeg). (Note: Profile photo will
be rejected.)
i. Signature Sign, Scan and upload your signature in BLACK ink only on white
background. (jpg, jpeg).
j. Aadhar Card (both sides) Upload Original card issued by Government of India.

NOTE – Upload GAP Affidavit with relevant documents / marks cards

and professional documents under Affidavit will be valid for 15 working days
from the date of notorization (Candidate who has failed to register within 12
months from the date of Diploma / Degree certificate issued)

Submission of Originals - As mentioned in Sl. No. 5

KARNATAKA PHARMACY COUNCIL REGISTERED

PHARMACIST WELFARE TRUST (KPCRPWT-A)
1. Eligibility:

➢ The applicant should be a Citizen of India and should been between 18 to 60 years of age to enroll under
KPCRPWT.
➢ The applicant must be a Registered Pharmacists in Karnataka State Pharmacy Council.

2. Benefits under this scheme:

IN CASE OF MEDICAL CLAIM IN CASE OF DEATH:

✓ A partial disbursement up to 1/3 of ✓ The quantum of amount of Rs.1,25,000/- to be given in case of death
the minimum amount for the which will be reviewed every year depending upon the trust resources.
medical treatment in case of serious ✓ Any partial amounts paid under medical claim will be deducted from final
illness such as cancer, cardiac settlement to the nominee.
surgery, kidney transplantation etc. ✓ Death Certificate issued by a competent authority in original shall be
to be decided by Trust Executive produced along with claim.
Committee on Merits. ✓ The claim shall be made in writing by the nominee whose is registered in
✓ A discharge certificate from the the trust.
Hospital / Nursing Home indicating ✓ In case the Registered nominee is not alive at the time of claim, only the
the brief report of illness and the legal heir approved by the court of law can make the claim producing the
treatment given should be produced proof of their legal heir rights. The claim should be made within 3 months
in original or a certified copy. or 90 days from the date of death.

3. Scan and keep ready all the following documents of the Nominee (Nominee should be blood relation
only)

Major Minor

1. Address proof of the Nominee 1. Proof of Date of Birth of the Nominee - Birth Certificate / School
2. Aadhar Card of the Nominee Certificate / Passport / Aadhar Card etc., (issued by competent authority).
3. Nominee Photo - Recent passport 2. Address proof of the Nominee
size colour photo which white 3. Aadhar Card of the Nominee
background only (jpg, jpeg). (Note: 4. Nominee Photo - Recent passport size colour photo which white
 Profile photo will be rejected.) background only (jpg, jpeg). (Note: Profile photo will be rejected.)
4. Nominee Signature - Sign and Scan 5. Nominee Signature - Sign and Scan your signature in BLACK ink only on
your signature in BLACK ink only on white background. (jpg, jpeg).
white background. (jpg, jpeg). 6. Self-attested address proof of the Guardian.
7. Aadhar Card of the Guardian
8. Guardian Photo - Recent passport size colour photo which white
background only (jpg, jpeg). (Note: Profile photo will be rejected.)
9. Guardian Signature - Sign and Scan your signature in BLACK ink only on
white background. (jpg, jpeg).

4. Payment made by NEFT: Counter foil of the payment remitted to KPCRPWT account should be uploaded.

Application Form - Print the copy of the auto generated Application Form sent to your mail, sign (in
BLACK ink only) and send all the original documents with 15" * 11" size self-addressed (Capital letters
only) non-terable cloth lined cover to KSPC office for verification within 7 working days.

ALSO MENTION ON COVER "ONLINE APPLICATION FOR FRESH APPLICATION"

Note:

1. If the applications are submitted by post / courier Original Certificates submitted by the
pharmacist will be returned along with the KSPC, KPCRPWT Certificate and ID Card issued by
the Council.

2. The Certificate issued by the Karnataka State Pharmacy Council will expire on 31st December
of the subsequent year of date of registration.

3. Retention of Name in the register - Renew every year before 31st of March as per Sec.34 of
the Pharmacy Act, 1948.

4. The council is nowhere responsible for any wrong information provided by the Candidate and
deviations from the original certificates. Please ensure proper filling of the application before
submission.

Updated on 16-10-2019