Name of Firm :  
  Full Address :  
  Phone :  
  Email :    
  Nature of Constitution :



  Name of Proprietor :  
  Mg.Partners :  
  Partners :  
  Name of Mg. Director :  
  Name of other contact Persons :  
  TIN :  
  CST No. :  
  Drug License No. :  
  Residential Address :  
  Remarks :
     
       
 
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