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Signature of the Head of the Institution Signature of the Inspectors1

PHARMACY COUNCIL OF INDIAStandard Inspection Format (S.I.F) for institutions conducting B. Pharm for 100 admns.

(To be filled and submitted to PCI by an organization seeking approval of the course / continuation of the approval)

To be filled up by P.C.I. To be filled up by inspectors

Inspection No. : Date of Inspection:

FILE No. : NAME OF THE INSPECTORS: 1. (BLOCK LETTERS)

(SIF-B-1)

2.PART – I

A - GENERAL INFORMATIONA – I .1Name of the Institution:

Complete Postal address:

STD codeTelephone No. Fax No.E-mail

K.B.RAVAL COLLEGE OF PHARMACYAt-Shertha, Post-Kasturinagar Ta & Distt- Gandhinagar-382423, Gujarat

07923285315/[email protected]

Year of starting of the course 2006Status of the course conducting body: Government / University / Autonomous / Aided / Private (Enclose copy of Registration documents ofSociety/Trust)

Trust

A – I .2Name, address of the Society/Trust/ Management (attach documentary evidence)STD Code: Telephone No: Fax No:E-mail Web Site:

A.K. RAVAL CHARITABLE TRUST,Tarpan, Plot No 808 B/H St. Xaviers High School, Sector-8 Gandhinagar-3800080792324308707923285311info@kbrtec.orgwww.kbrtec.org

A – I .3Name, Designation and Address of person to be contacted by phone

STD Code Telephone No Office Residence Mobile No.Fax No E-Mail

Sh. Kedarnath Kantilal RavalHon. SecretaryTarpan, Plot No 808 B/H St. Xaviers High School, Sector-8 Gandhinagar-380008

0792324308707-2328531507923243087937619626707923285311kedar.kbrtec@gmail.com

A – I. 4Name and Address of the Head of the Institution

Dr. Ankit A. AjemraA/201 Mohini Tower, Bodakdev, Ahmedabad-38054

A –I . 5

FOR INSTITUTION SEEKING CONTINUATION OF APPROVAL


YES

No

Yes

YesNo

a. Details of Affiliation Fee PaidName of the Course Affiliation Fee paid up

toReceipt No Dated Remarks of the

InspectorsB. Pharm 2017-18 Not received 23/8/16

b. APPROVAL STATUS:

Name of the

Course

Approved up to

In take Approved and

Admitted

PCI STATE GOVERNMENT

UNIVERSITY Remarks of the Inspectors

B. Pharm 2016-17 Approval Letter No and Date

2.272 EC meeting on date: 3/8/16

Copy attached GTU/INSTI_AFFIL/224/2015-16/820

DATED:15/2/2016

Approved Intake 60 60 60Actually Admitted

15 15 15

c. STATUS OF APPLICATION

COURSES INSPECTED FORFaculty / Subject

Extension of Approval Increase in Intake of Seats RemarksCurrent Intake Proposed increase in

IntakeB. Pharm Yes Yes 60 100

Note: Enclose relevant documents A –I. 6Whether other Educational Institutions/Courses are also being run by the Trust / Institution in the same

Building / campus? If Yes, Give Details Yes

A – I. 6 a

Yes √ No

Status of the Pharmacy Course:

Independent Building

Wing of another college

Separate Campus

Multi Institutional Campus

Examining Authority With complete postal Address, Telephone No. and STD Code.

GUJRAT TECHNOLOGICAL UNIVERSITY , Nr.Vishwakarma Government Engineering CollegeNr.Visat Three Roads, Visat - Gandhinagar HighwayChandkheda, Ahmedabad – 382424 - Gujarat ,STD Code : : 079 T.No. : 23267521/570 Fax No. : 079-23267580 E.Mail: [email protected] site: http://www.gtu.ac.in

http://www.gtu.ac.in/

mailto:[email protected]


B - DETAILS OF THE INSTITUTION

B –I .1Name of the Principal

Dr. Ankit A. Ajmera

Qualification/ Experience

Qualification*Teaching Experience

RequiredActual

experienceRemarks of the

InspectorsM. Pharm Yes 15 years, out of which 5 years as

Prof. / HOD 20 years

PhD Yes 10 years, out of which at least 05 years as Asst. Prof

* Documentary evidence should be provided B –I .2For institution seeking continuation of affiliation

Course Date of last Inspection

Remarks of the Previous Inspection Report

Complied/ Not

Complied

Intake reduced/Stopped in the last 03 years*

B. Pharm 10/8/2015 staff deficiency 7 principal relieving letter is missing PF for teaching staff library shared with MCA

complied No

* Enclose Documents

B –I .3Status of Governing Council: TrustDetails of the Governing Body Enclosed Minutes of the last Governing council Meeting Enclosed

B –I .4Pay Scales:Staff Scale of pay PF Gratuity Pension

benefitRemarks of

the Inspectors

Teaching Staff

AICTE /UGC/State Govt. Yes No No No

Non- Teaching Staff

State Government Yes Yes No No

B –I .5

B. Pharm Course: Admission Statement for the Past Three Years

ACADEMIC YEAR Year 2014-15 Year 2015-16 Year 201617

Sanctioned 60 60 60No. of Admissions 18 39 60Unfilled Seats 42 21 0No. of Excess Admissions

0 0 0


B –I .6Academic information: Percentage of UG results for the past three years based on University Calendar

ACADEMIC YEAR Year 2013-14 Year 2014-15- Year 2015-161st year 20 13 412nd year 38 5 123rd year 52 67 34Final year 51 86 100Pass % (Final Year) 51 86 100

B – IICo – Curricular Activities / Sports ActivitiesWhether college has NSS Unit (Yes/No)? If no give reasons

No, Due to Location

NSS Programme Officer’s NameProgramme conducted (mention details)Whether students participating in University level cultural activities / Co- curricular/sports activities

Yes

Physical Instructor Not availableSports Ground Individual


C - FINANCIAL STATUS OF THE INSTITUTION

Audited financial Statement of Institute should be furnished C .1

Resources and funding agencies (give complete list)

C .2 Please provide following InformationReceipts Expenditure Remarks

of the Inspectors

Sl.No.

Particulars Amount Sl.No.

Particulars Amount

1. Grantsa. Governmentb. Others

0CAPITAL EXPENDITURE

2. Tuition Fee 5698350 1. Building 34405883

3. Library Fee 0 2. Equipment 8836389

4. Sports Fee 0 3. Others 0

5. Union Fee 0 REVENUE EXPENDIUTRE

6. Others 0 1 Salary 3045438

2. MAINTENANCE EXPENDITURE

i College 214864

ii Others 1271303. University Fee (If

any)124768

4. Apex Bodies Fee 2000005. Government Fee 06. Deposit held by

the College0

Total7. Others 08. Misc.Expenditure 1013110

Total 4725310

Note: Enclose relevant documents


PART- II PHYSICAL INFRASTRUCTURE1. a. Availability of Land (B. Pharm courses) : Available

a) 2.5 acres District HQ/Corporation/Municipality limitb) 0.5 acre for City / Metros

b. Building : Ownc.Land Details to be in name of Trust and Society

Records to be enclosedSale deed : Enclosed

d. Building†:i) Approved Building plan, to be Enclosed : Enclosed

e. Total Built Area of the college building in Sq.mts : Built up Area 4017

Amenities and Circulation Area 9162. Class rooms:

Total Number of Class rooms provided at the end of 4 Year Course

Class Required Nos

Available Nos

Required Area * for each class room

Available Area in Sq.mts

Remarks of the

InspectorsB. Pharm 06 06 6 of 90 Sq. mts Or

4 of 150 sq.mts. with Public address System.

450

(*To accommodate 100 students).3. Laboratory requirement at the end of 4 Years

*Number of laboratories required for entire course of 4 years.

Sl.No.

Infrastructure for Requirement as per Norms Available No. &

Area in Sq mts

Remarks/ Deficiency

1 Laboratory Area for B.Pharm Course (12 Labs)

90 Sq .mts x n (n=10) - Including Preparation room - Desirable75 Sq. mts - Essential

12 & 1041

2 Pharmaceutics Pharmaceutical Chemistry Pharmaceutical Analysis Pharmacology PharmacognosyPharmaceutical Biotechnology (Including Aseptic Room)

Total no. Laboratories for B.Pharm course

03 Laboratories02 Laboratories1 Laboratory2 Laboratories01 Laboratories01 Laboratory

10 Laboratories *

3 & 2562 & 1681 & 832 & 1701 & 83

9

3 Preparation Room for each lab(One room can be shared by two labs, if it is in between two labs)

10 sq mts (minimum)

1 & 10

4 Area of the Machine Room 80-100 Sq.mts 1 & 1005 Central Instrumentation Room 80 Sq.mts with A/ C 1 & 986 Store Room – I 1 (Area 100 Sq mts) 1 & 1007 Store Room – II

(For Inflammable chemicals)1 (Area 20 Sq mts) 1 & 36


† The Institutions will not be permitted to run the courses in rented building on or after 31.12.20081. All the Laboratories should be well lit & ventilated2. All Laboratories should be provided with basic amenities and services like exhaust fans and fume chamber to

reduce the pollution wherever necessary.3. The work benches should be smooth and easily cleanable preferably made of non-absorbent material.4. The water taps should be non-leaking and directly installed on sinks. Drainage should be efficient.5. Balance room should be attached to the concerned laboratories.

4. Administration Area:

Sl.No. Name of infrastructure Requirement as per Norms

in number

Requirement as per Norms,

in area

Available Remarks/ Deficiency

No. Area in Sq .mts

1 Principal’s Chamber 01 30 Sq .mts 1 302 Office – I - Establishment

01 60 Sq. mts111

38512

3 Office – II - Academics4 Confidential Room

5. Staff Facilities:

Sl. No. Name of infrastructure Requirement as per Norms

in number


in area


No. Area in Sq mts

1 HODs for B.Pharm Course Minimum 4 20 Sq mts x 4 4 802 Faculty Rooms for B.Pharm

course10 Sq mts x n (n=No of teachers)

4 141

6. Museum, Library, Animal House and other Facilities

Sl.No. Name of infrastructure

Requireme nt as per Norms in number

Requirement as per Norms, in area


No. Area in Sq. mts

1 Animal House 01 80 Sq mts 1 1172 Library 01 150 Sq mts 1 4003 Museum 01 50 Sq mts (May

be attached to the Pharmacognosy lab)

1 97

4 Auditorium / Multi Purpose Hall (Desirable)

01 250 – 300 seating capacity

1 158

5 Seminar Hall 01 1 536 Herbal Garden

(Desirable)01 Adequate Number of

Medicinal Plants2 616


7. Student Facilities:

Sl.No.

Name of infrastructure Requirement as per Norms

in number


in area


No. Area in Sq .mts

1 Girl’s Common Room (Essential)

0160 Sq.mts

1 77

2 Boy’s Common Room (Essential)

0160 Sq.mts

1 86

3 Toilet Blocks for Boys 01 24 Sq.mts 3 724 Toilet Blocks for Girls 01 24 Sq.mts 3 725 Drinking Water facility – Water

Cooler (Essential).01 2 50

6 Boy’s Hostel (Desirable) 01 9 Sq .mts / RoomSingle occupancy

0

7 Girl’s Hostel (Desirable) 01 9 Sq .mts / Room (single occupancy) 20 Sq mts / Room

(triple occupancy)

0

8 Power Backup Provision (Desirable)

01 1 20

8. Computer and other Facilities:

Name Required Available Remarks of the

InspectorsNo. Area in Sq. mts

Computer Room for B.Pharm Course

01(Area 75 Sq mts)

1 159

Computer(Latest Configuration)

1 system for every 10 students 63 0

Printers 1 printer for every 10 computers

7 0

Multi Media Projector 01 3 0Generator (5KVA) 01 1 0


9. Amenities (Desirable)

Name Requirement as per Norms in

area

Available Not Available

Remarks/ DeficiencyNo. Area in Sq.

mtsPrincipal quarters 80 Sq. mts 0 0Staff quarters 16 x 80 Sq. mts 0 0Canteen 100 Sq. mts 1 500Parking Area for staff and students 2 875Bank Extension Counter 0 0Co operative Stores 0 0Guest House 80 Sq. mts 1 23Transport Facilities for students 2 0Medical Facility (First Aid) 1 10

10. A. Library books and periodicalsThe minimum norms for the initial stock of books, yearly addition of the books and the number of journals to be subscribed are as given below:

Sl.No.

Item Titles (No)

Minimum Volumes (No) Available Remarks of the

InspectorsTitle Numbers

1 Number of books 150 2000 adequate coverage of a large number of standard text

books and titles in all disciplines of pharmacy

1353 4902

2 Annual addition of books 150 to 200 books per year

17 148

3 PeriodicalsHard copies / online

10 National05 International periodicals

10 235

4 CDS Adequate Nos 30 385 Internet Browsing Facility Yes/No (Minimum

ten computers)Available

6 Reprographic Facilities: Photo CopierFax Scanner

010101

AvailableAvailableAvailable

7 Library Automation and Computerized System : Available8 Library Timings : 9: 00 am to 5.30 pm[

10.B. Library Staff:

Staff Qualification Required Available Remarks of the Inspectors

1 Librarian M. Lib 1 Available2 Assistant Librarian D. Lib 1 Not Available3 Library Attenders 10 +2 / PUC 2 Available


PART III ACADEMIC REQUIREMENTSCourse Curriculum:

1. Student Staff Ratio: Theory Practical Remarks of the Inspectors

(Required ratio --- Theory → 60:1 and Practical → 20:1) If more than 20 students in a batch 2 staff membersto be present provided the lab is spacious.

2. Scheme of B. Pharm Course: Semester

3. Date of Commencement of session / sessions:

No of Days No of Days

4. Vacation: Summer: 45 Winter: 21

5. Total No. of working days: 193

6. Time Table:

Time Table for B. Pharm course Enclosed Yes

7. Whether the prescribed numbers of classes are being conducted as per university norms I B. Pharm:

Commencement Completion20/06/16 18/06/17

Subject

1

No of Theory Classes

PracticalsRemarks of

the Inspectors

Prescribed No of

Hrs

No of Hours

Conducted

3

Prescribed No of Hours

4

No of Hours Conducted

5

No of Classes Conducted to fulfill Prescribed

Number of Hours as in Column 5 No. of classes

x hours per classPharm Chem I 45 45 45 45 15Human anatomy physiology I

60 60 45 45 15Basic computer application I 45 45 45 45 15

Pharm Chem II 45 45 45 45 15Physical pharmacy I 45 46 45 45 15Unit operation I 60 60 45 45 15Human anatomy physiology II

60 60 45 45 15Basic comuter application II 30 30 45 45 15Pharm. Analysis I 60 60 45 45 15Pharm. Analysis II 60 61 45 45 15CPD 60 60 0 0 0Environmental studies 45 45 0 0 0


II B. Pharm:

Subject 1No of Theory Classes

PracticalRemarks of

the Inspectors

Prescribed No of

Hrs

2

No of Hours Conducted 3

Prescribed No

of Hours

4

No of Hours

Conducted 5

No of Classes Conducted to fulfill Prescribed Number of

Hours as in Column 5No. of classes x hours per

class

Pharm Chemistry III

45 45 45 45 15Pharm Chem V 45 45 45 45 15Pharm Engineering I

45 45 45 45 15Pharmacognosy I 45 45 45 45 15Pharm Chem IV 45 45 45 45 15 Pharm Chem VI 45 45 45 45 15Dispensing Pharmacy I

45 45 45 45 15Pharmacognosy II 45 45 45 45 15HECH 45 45 0 0 0Pharmacology and CP

45 45 0 0 0Dispensing Pharmacy II and

45 45 45 45 15Unit operation II 45 45 45 45 15

Yes NoYes


III B. Pharm:

Subject 1No of Theory Classes Practical

Remarks of the

Inspectors

Prescribed No of Hrs

2



4


No of Classes Conducted to fulfill Prescribed Number

of Hours as in Column 5

No. of classes x Pharm Chem VII 45 45 45 45 15Pharmacology and Pharmacotherapeutics

45 45 45 48 16Hospital Pharmacy and Community Pharmacy 45 45 0 0 0Microbiology I 45 45 45 48 16Pharmacognosy III 45 45 45 45 15Pharmacognosy IV 45 45 45 45 15Pharm Chem VIII 45 45 45 45 15Microbiology II 45 45 45 48 16Pharm. analysis III 45 45 45 45 15Pharm. analysis IV 45 45 45 45 15Pharmacology and Pharmacotherapeutics II

45 45 45 48 16Forensic Pharmacy 45 45 0 0 0

IV B. Pharm:

Subject 1No of Theory Classes Pra

ctical

Remarks of the

Inspectors

Prescribed No of Hrs

2



4

No of Hours

Conducted 5

No of Classes

Conducted to fulfill

Prescribed Number of Current advance s in

novel drug delivery system 45 45 0 0 0Pharm Technology I 45 45 45 45 15Pharm Chem IX 45 45 45 45 15Pharmacology III 45 45 45 45 15DFD -I 45 45 45 45 15Pharmacognosy V 45 45 45 45 15Pharmacology III 45 45 45 45 15Pharmacognosy VI 45 45 45 45 15Pharm Chem X 45 45 45 45 15Current advance s in novel drug delivery

45 45 0 0 0DFD II 45 45 45 45 15Pharm technology II 45 45 45 45 15

8 . Whether Tutorials are being conducted (if any, as per university norms)


9. Number of Guest Lectures / Seminars / Workshops / Symposia / Presentations conducted during lastThree years.

A.Name of the Event Year 2013-14 Year 2014-15 Year 2015-16Guest Lectures 3 4 6Seminars 1 0 0Workshops 0 0 0Symposia 0 0 0

B. Papers Presented / Published during last three years

Year 2013-14 Year 2014-15 Year 2015-16National International National International National International

Published 4 2 3 1 1 1Presented 0 0 0 0 0 0


10. Whether Internal Assessments are conducted periodically as per university norms

Yes √ No

ClassI Sessional Dates DD/MM/YY II Sessional Dates

DD/MM/YYIII Sessional Dates

DD/MM/YYRemarks of the

InspectorsTheory Practical Theory Practical Theor

yPractical

I B. Pharm 02/12/2015 To11/12/2015

02/12/2015 To11/12/2015

21/04/2016 To29/04/2016

21/04/2016 To29/04/2016

II B. Pharm 18/09/2015 To30/09/2015

18/09/2015 To30/09/2015

18/04/2016 To 02/05/2016

18/04/2016 To 02/05/2016

III B. Pharm 18/09/2015 To30/09/2015

18/09/2015 To30/09/2015

30/03/2016 To13/04/2016

30/03/2016 To13/04/2016

IV B. Pharm 18/09/2015 To30/09/2015

18/09/2015 To30/09/2015

20/03/2016 To01/04/2016

20/03/2016 To01/04/2016

11. Whether Evaluation of the internal assessments is Fair Yes √ No

Class

No. of Candidates scored more than

80%

No. of Candidates scored between 60

- 80%

No. of Candidates scored between 50

- 60%

No. of Candidates Less

than 50%

Remarks of the

InspectorsTh Pr Th Pr Th Pr Th Pr

I B.Pharm 9 14 15 18 6 0 2 0II B.Pharm 1 4 5 5 2 0 1 0III B.Pharm 2 3 10 15 6 0 0 0IV B.Pharm 0 1 2 1 0 0 0 0

12. Work load of Faculty members for B. Pharm

Sl. No

Name of the Faculty Subjects taught B. Pharm Total work load

Specific Remarks of the InspectorTh Pr

1 Dr. Ankit A Ajmera Pharmaceutics 2 0 22 Pranit B Patel Pharmacognosy 2 3 53 Dr. Keyur S Patel Pharmaceutics 1 3 44 Jaya M Patel Pharmacognosy 10 6 165 Kinjal B Rathod Pharmaceutics 3 0 36 Sejal R Kharadi Pharmaceutics 6 3 97 Dr. Smita M Talaviya Pharma. Chemistry 3 0 3

8 Sandip N Badeliya Pharma. Chemistry 3 9 129 Vidhi S Dave Pharmachemistry (QA) 0 6 610 Pankti P Dalwadi Pharmacology 8 6 1411 Krunal B Patel Pharmaceutics 5 3 812 Yogeshkumar N Patel Quality Assurance 3 6 913 Hitesh P Patel Pharmaceutics 5 6 1114 Sejal A Madhak Pharmaceutics 3 12 1515 Drashtiben D Mandali Quality Assurance 4 9 1316 Jaiminkumar R Patel QualityAssurance 3 6 09


17 Jaykumar Panchani Pharmaceutics 4 6 1018 Kanal S Joshi Quality Assurance 0 0 019 Rahulgiri Goswami Quality Assurance 5 0 520 Rinku Patel Pharmacognosy 0 0 021 Jaimin B. Patel Pharmaceutics 0 0 022 Darpini S.Patel Pharma. Chemistry 0 0 023 Jainish A. Shah Quality Assurance 0 0 0

13. Percentage of students qualified in GATE in the last Three Years

Details Year 2013-14 Year 2014-15 Year 2015-16No. of Students Appeared 10 4 2No. of Students Qualified 2 2 0Percentage 20 50 0

14. Whether the Institution has an Industry – Institution Interaction cell Yes √ No

If applicable please give the details for the previous Year

Events Details for the Previous YearNo. of Industrial visits 1Industrial Tour 0Industrial Training 0No. of Resource Persons from the Industry for Guest Lectures 6No. of Collaboration projects with Industry 0

Yes No


15. Percentage of students Placed through the College Placement Cell in the Last Three Years

Year Year 2013-14 Year 2014-15 Year 2015-16No. of students appeared for campus interview

2 12 4

% Placed 100 20 25

16. Whether Professional Society Activities are Conducted (Enclose Details) (ISTE, IPA, APTI, ICTA and Related Societies)

√


PART IV - PERSONNEL

TEACHING STAFF:

1. Details of Teaching Faculty for B.Pharm Course to be enclosed in the format mentioned below:

Sl No

Name Designation QualificationDate of Joining

Teaching Experience

State Pharma

cy Council Reg No.

Signature of the faculty

Remarks of the

InspectorsAfter PG

1 DR. ANKIT A AJMERA

Principal B.Pharm, M.Pharm, Ph.D

20/8/2013 3.0+17.3 G12091

2 Pranit B Patel Associate ProfessorB.Pharm,M.Pharm 6/8/2009 7.0 + 17.7 G89633 Dr. Keyur S Patel Assistant Professor B.Pharm, M.Pharm,

Ph.D27/8/2009 7.0 +2.2 G24633

4 Kinjal Rathod Assistant Professor B.Pharm,M.Pharm 17/8/2009 7.0 +1.0 G26042

5 Rinkuben Patel Assistant Professor B.Pharm,M.Pharm 16/7/2007 9.1 +0.0 G234246 Dr. Smita Talaviya Assistant Professor B.Pharm, M.Pharm,

Ph.D16/8/2010 6.0 +1.9 G30796

7 Dave Vidhi S. Assistant Professor B.Pharm, M.Pharm, 27/1/2015 1.6 +0.0 G450838 Pankti P. Dalwadi Assistant Professor B.Pharm,M.Pharm 06/7/2015 1.2 +0.0 G499479 Kharadi Sejal R. Assistant Professor B.Pharm,M.Pharm 31/5/2016 0.3 +6.0 G2349810 Badeliya

Sandipkumar N.Assistant Professor B.Pharm,M.Pharm 1/3/2016 0.5 +5.9 G29759

11 Jaya M. Patel Assistant Professor B.Pharm,M.Pharm 18/1/2016 0.6 +6.9 G2530012 Patel Yogesh Assistant Professor B.Pharm,M.Pharm 31/5/2016 0.3 +0.0 G2514913 Patel Hitesh Assistant Professor B.Pharm,M.Pharm 31/5/2016 0.3 +0.0 G3290214 Patel Krunal B. Assistant Professor B.Pharm,M.Pharm 31/5/2016 0.3 +0.0 G5585715 Panchani Jay R. Assistant Professor B.Pharm,M.Pharm 1/8/2016 0.1 +0.0 G5764116 Goswami Rahulgiri R Assistant Professor B.Pharm,M.Pharm 31/5/2016 0.3 +0.0 G6067517 Patel Jaiminkumar R. Assistant Professor B.Pharm,M.Pharm 1/8/2016 0.1 +0.0 G3939718 Mandali Drashti D. Assistant Professor B.Pharm,M.Pharm 1/8/2016 0.1 +0.0 G4837119 Madhak Sejalben A. Assistant Professor B.Pharm,M.Pharm 31/5/2016 0.3 +0.0 G3675520 Kanal S Joshi Assistant Professor B.Pharm,M.Pharm 30/8/2016 0.0 + 0.0 G5660821 Jaimin B. Patel Assistant Professor B.Pharm,M.Pharm 01/9/16 0.0 + 0.0 G5923922 Darpini S.Patel Assistant Professor B.Pharm,M.Pharm 06/9/16 0.0 + 0.0 G2913823 Jainish A. Shah Assistant Professor B.Pharm,M.Pharm 01/10/16 0.0 + 0.0 G28164

2. Qualification and number of Staff Members

QualificationM. Pharm PhD Others - Full Time

23 3


3. Teaching Staff required year wise exclusively for B.Pharm for intake of 100 Students.

No. of staff required1. Pharmaceutical Chemistry2. Pharmaceutical Analysis3. Pharmacology4. Pharmacognosy5. Pharmaceutics6. Pharmacy Practice7. Principal

7244611

Total 25

*Part time teaching Staff 3

Remarks of the Inspection Team

*Part time teaching staff for Mathematics, Biology and Computer Science can be appointed.


4. Staff Pattern for B. Pharm courses Department wise / Division wise:Professor: Asst. Professor: Lecturer

Department / Division Name of the post For strength of 100

students

Provided by the

institution

Remarks of inspection team

Department of Pharmaceutics Professor 1 1

Asst. Professor 2 8

Lecturer 3 0

Department of Pharmaceutical Chemistry

Professor 1 0Asst. Professor 3 3Lecturer 3 0

Department of Pharmacology Professor 1 0Asst. Professor 2 1Lecturer 1 0

Department of Pharmacognosy Professor 1 1Asst. Professor 1 2Lecturer 2 0

Department of Pharmacy Practice

Asst. Professor 1 0Lecturer 1 0

Department of Pharmaceutical Analysis

Asst. Professor 1 7Lecturer 1 0

5. Selection criteria and Recruitment Procedure for Faculty:

a. Whether Recruitment Committee has been formed Yes

b. Whether Advertisement for vacancy is notified in the Newspapers Yes

c. Whether Demonstration Lecture has been conducted Yes

d. Whether opinion of Recruitment Committee Recorded Yes

6.Details of Faculty Retention for:

Name of Faculty Member Period

%NA Duration of 15 yrs. and aboveNA Duration of 10 yrs. and above

Rinku Patel, Ankit Ajmera, Patel Keyur S Mr.Pranit B Patel, Rathod Kinjal B, Smita Talvaiya Duration of 5 yrs. and above 26Vidhi Dave, Pankti Dalwadi, sandip Badeliya, jaya patel, Sejal Kharadi, Yogesh patel, Sejal madhak, Rahulgiri Goswami, Panchani jay, Krunal patel, Hitesh patel, Drashti Mandali, Jaimin Patel Kanal Joshi, Jainin Patel, Darpini patel, Jainish Shah

Less than 5 yrs. 74

7. Details of Faculty Turnover:

Name of Faculty Member Per

More than 50%

50% 25% Less than 25%

Maulik Acharya,Pranav Patel, vivek dabhi, shreya shah, munira, parul parmar, jignesh patel, jigar patel Sejal Kharadi, Haresh Chaudhry, Pratik patel, Jignesh patel, Dhaval Acharya, Dr. Sagar Solanki, Kajal Chauhan

% of faculty retained in last 3 yrs

Yes


8.Number of Non-teaching staff available for B. Pharm course for intake of 100 Students:

Sl.No.

Designation Required (Minimum)

Required Qualification

Available Remarks of the Inspection teamNumber Qualification

1 Laboratory Technician 1 for each Dept

D. Pharm 1 B.Pharm

2 Laboratory Assistants / Attenders

1 for each Lab (minimum)

SSLC 1 B.Pharm

3 Office Superintendent 1 Degree 1 Degree4 Accountant 1 Degree 2 Degree5 Store keeper 1 D. Pharm/

Degree1 D.Pharm

6 Computer Data Operator 1 BCA /Graduate

with Computer

Course

1 M.C.A

7 Office Staff I 1 Degree 1 Degree8 Office Staff II 2 Degree 2 Degree9 Peon 2 SSLC 9 SSC10 Cleaning personnel Adequate --- 2 Middle11 Gardener Adequate --- 2 Middle

9. Scale of pay for Teaching faculty (to be enclosed):Sl.No

Name Qualification Designation Basicpay R

DP DARs.

HRARs.

CCARs.

Otherallowa

nce Rs.

Deductions

BankA/C No

PANNo

EPFA/c n

Total Signature

P T

TDS

EPF

1 DR. ANKIT A AJMERA

B.Pharm, M.Pharm, Ph.D

Principal 18650 9325 20422 1399 500 2000 0 006401003428 ACBPA1882H 0 52296

2 Pranit B Patel B.Pharm,M.Pharm Associate Professor 16850 8425 21989 1164 100 400 0 06401011751 ADSPP7158D 0 490283 Dr. Keyur S Patel B.Pharm,

M.Pharm, Ph.DAssistant Professor 9100 4550 11876 683 100 3692 0

118301507382 APGPP1678G 0 30000

4 Kinjal Rathod B.Pharm,M.Pharm Assistant Professor 9100 4550 11876 683 100 400 0 118301507386 APFPR6370A 0 267085 Rinkuben Patel B.Pharm,M.Pharm Assistant Professor 9375 4688 12234 703 100 400 0 118301507384 BBQPP2831Q 0 275006 Dr. Smita Talaviya B.Pharm,

M.Pharm, Ph.DAssistant Professor 9375 4688 12234 703 100 400 0

016501531725 AIXPT1394F 0 27500

7 Dave Vidhi S. B.Pharm, M.Pharm,

Assistant Professor 8000 4000 10440 600 100 400 0 029501529569 BOKPD4987A 0 235408 Pankti P. Dalwadi B.Pharm,M.Pharm Assistant Professor 8000 4000 10440 600 100 400 0 354601500876 BPPPD3126K 0 235409 Kharadi Sejal R. B.Pharm,M.Pharm Assistant Professor 8000 4000 10440 600 100 400 0 118301507455 BVGPK2670G 0 2354010 Badeliya

Sandipkumar N.B.Pharm,M.Pharm Assistant Professor 8000 4000 10440 600 100 400 0 016501538102 AZVPB7673C 0 23540

11 Jaya M. Patel B.Pharm,M.Pharm Assistant Professor 8000 4000 10440 600 100 400 0 016501538101 AYPPP9815K 0 2354012 Patel Yogesh B.Pharm,M.Pharm Assistant Professor 8000 4000 10440 600 100 400 0 32450150043 CKRPP8646J 0 2354013 Patel Hitesh B.Pharm,M.Pharm Assistant Professor 8000 4000 10440 600 100 400 0 324501500050 BXEPP2479J 0 2354014 Patel Krunal B. B.Pharm,M.Pharm Assistant Professor 8000 4000 10440 600 100 400 0 029401535008 CRXPP4894B 0 2354015 Panchani Jay R. B.Pharm,M.Pharm Assistant Professor 8000 4000 10440 600 100 400 0 029401535421 CQPTPP565N 0 2354016 Goswami Rahulgiri R B.Pharm,M.Pharm Assistant Professor 8000 4000 10440 600 100 400 0 029401535008 BGLPG6417R 0 2354017 Patel Jaiminkumar R.B.Pharm,M.Pharm Assistant Professor 8000 4000 10440 600 100 400 0 029401535425 AULPP4936H 0 2354018 Mandali Drashti D. B.Pharm,M.Pharm Assistant Professor 8000 4000 10440 600 100 400 0 AAAAA0000A 0 2354019 Madhak Sejalben A. B.Pharm,M.Pharm Assistant Professor 8000 4000 10440 600 100 400 0 34501523009 BITPM8736N 0 2354020 Kanal S Joshi B.Pharm,M.Pharm Assistant Professor 8000 4000 10440 600 100 400 0 BEZPJ3396A 0 23540

21 Jaimin B. Patel B.Pharm,M.Pharm Assistant Professor 8000 4000 10440 600 100 400 0 CEYPP3648B 0 23540

22 Darpini S.Patel B.Pharm,M.Pharm Assistant Professor 8000 4000 10440 600 100 400 0 AUMPP4262H 0 23540

23 Jainish A. Shah B.Pharm,M.Pharm Assistant Professor 8000 4000 10440 600 100 400 0 BVJPSS5778N 0 23540

10. Whether facilities for Research / Higher studies are provided to the faculty?(Inspectors to verify documents pertaining to the above) : Yes

11. Whether faculty members are allowed to attend workshops and seminars?(Inspectors to verify documents pertaining to the above) : Yes

12. Scope for the promotion for faculty: Promotions Yes √ No

13. Gratuity Provided Yes √ No

14. Details of Non-teaching staff members (list to be enclosed):

Sl No

Name Designation Qualifi cation

Date of Joining

Experience Signature Remarks of the Inspectors

1 C.H.Bhatt Administrative Officer B A L Lb 01/09/2006 39

2 Mahesh B Chauhan Librarian M Lib 05/06/2006 9 3 Revabhai M Prajapati Peon SSC 05/01/2006 9 4 Nayak Dhruvil Labortory

Assistants B Pharm 28/08/2013 1

5 Bhartiben N Patel Peon SSC 28/11/2008 6 6 Dinesh G Parmar Peon SSC 05/01/2006 9 7 Rajesh Pathak Peon HSC 14/08/2010 2 8 Maheshji Thakor Peon SSC 05/01/2010 4 9 Thakor Jagaji Peon Middle 24/07/2007 5 10 Makwana Naynaben D Cleaning personnel Middle 11/01/2011 2 11 Mehta Parul Accountant Bcom 03/08/2015 9 12 Patel Amitbhai R Computer Data

Operator MCA 16/08/2010 5

13 Jay kumar Parmanand Sain Laboratory Technician

BPharm 01/07/2015 1 14 Ashok Vaghela Cleaning personnel Middle 08/01/2015 3 15 Thakor Kanubhai Gardener Middle 09/10/2011 4 16 Kisan Dantani Peon Middle 15/09/2015 1 17 Bhartiben Dantani Peon middle 15/09/2015 1 18 Vinodbhai Dantani Gardener middle 15/08/2015 1 19 Barot Jitubhai Peon middle 12/07/2016 02 20 Vishnubhai Patel Accountant middle 20/07/2016 02 21 DARJI HETAL R Lecturer MCA 01/11/2012 4

15. Whether Supporting Staff (Technical and Administrative) are encouraged for skill up gradation programs. Yes


PART V - DOCUMENTATIONRecords Maintained: Essential

Sl. No Records Yes No Remarks of the

Inspectors

1 Admissions Registers √2. Individual Service Register √3. Staff Attendance Registers √4. Sessional Marks Register √5. Final Marks Register √6. Student Attendance Registers √7. Minutes of meetings- Teaching Staff √8. Fee paid Registers √9. Acquittance Registers √

√10. Accession Register for books and Journals in Library √11. Log book for chemicals and Equipment costing more than Rupees

one lakh√

12. Job Cards for laboratories √13. Standard Operating Procedures (SOP’s) for Equipment √14. Laboratory Manuals √15. Stock Register for Equipment √16. Animal House Records as per CPCSEA √


Signature of the Head of the Institution Signature of the Inspectors

PART - VI

1. Financial Resource allocation and utilization for the past three years: (Audited Accounts for previous year to be enclosed)

Sl Expenditure in Rs.2014-2015

Expenditure in Rs.2015-2016

Expenditure in Rs2016-2017

Remarks of the Inspectors*

No. Total budget

sanctioned

Recurring Non Recurring

Total budget

sanctioned

Recurring Non Returning

Total budget sanctioned

Recurring Non Returning

1 1500000 500000 500000 1600000 1100000 500000 1250000 50000 1200000

2. Total amount spent on chemicals and glassware for the past three years:





No. Total budget

allocated

Sanctioned Incurred Total budget

allocated


allocated

Sanctioned Incurred

1 Chemicals 500000 0 Chemicals 700000 0 Chemicals 400000 02 Glassware 200000 0 Glassware 200000 0 Glassware 200000 0

3. Total amount spent on equipments for the past three years: (Enclose purchase invoice)





No. Total budget

allocated


allocated


allocated

Sanctioned Incurred

Equipment 500000 0 Equipment 500000 0 Equipment 500000 0


4. Total amount spent on Books and Journals for the past three years:

Sl No.

Expenditure in Rs. Expenditure in Rs. Expenditure in Rs Remarks of the Inspectors*

Total budget

allocated


allocated


allocated

Sanctioned Incurred

1 Books 200000 0 Books 100000 0 Books 100000 500002 Journals 100000 0 Journals 100000 0 Journals 150000 0

*Last three years including this academic year till the date of inspection

`


PART VII – EQUIPMENT AND APPARATUS

Department wise list of minimum equipments required for B. Pharm (for a batch of 20 students)

DEPARTMENT OF PHARMACOLOGYEquipment:

Sl. No. Name Minimum required Nos. Available Nos.

Working Yes / No

Remarks of the Inspectors

1 Microscopes 20 20 Yes2 Haemocytometer with Micropipettes 20 25 Yes3 Sahli’s haemocytometer 20 27 Yes4 Hutchinson’s spirometer 01 1 Yes5 Spygmomanometer 10 10 Yes6 Stethoscope 10 10 Yes7 Permanent Slides for various tissues One pair of each tissue Organs

and endocrine glandsOne slide of each organ system

30 Yes

8 Models for various organs One model of each organ system

25 Yes

9 Specimen for various organs and systems One model for each organ system

15 Yes

10 Skeleton and bones One set of skeleton and one spare bone

1 of each Yes

11 Different Contraceptive Devices and Models One set of each device 2 Yes12 Muscle electrodes 01 1 Yes13 Lucas moist chamber 01 1 Yes14 Myographic lever 01 1 Yes15 Stimulator 01 1 Yes16 Centrifuge 01 1 Yes17 Digital Balance 01 2 Yes18 Physical /Chemical Balance 01 3 Yes19 Sherrington’s Kymograph Machine /

Polyrite10 31 Yes


20 Sherrington Drum 10 31 Yes21 Perspex bath assembly (single unit) 10 30 Yes22 Aerators 10 19 Yes23 Computer with LCD 01 1 Yes24 Software packages for experiment 01 1 Yes25 Standard graphs of various drugs Adequate number 6 Yes26 Actophotometer 01 1 Yes27 Rotarod 01 1 Yes28 Pole climbing apparatus 01 1 Yes29 Analgesiometer (Eddy’s hot plate and

radiant heat methods)01 1 Yes

30 Convulsiometer 01 1 Yes31 Plethysmograph 01 1 Yes32 Digital pH meter 01 1 Yes

Apparatus:

Sl. No. Name Minimum required No.s Available Nos.

Working Yes / No


1 Folin-Wu tubes 60 60 Yes2 Dissection Tray and Boards 10 20 Yes3 Haemostatic artery forceps 10 10 Yes4 Hypodermic syringes and needles of size 15,24,26G 10 10 Yes

5 Levers, cannulae 20 20 YesNOTE: Adequate number of glassware commonly used in the laboratory should be provided in each laboratory and department.

DEPARTMENT OF PHARMACOGNOSYEquipment:Sl. No. Name Minimum required Nos. Available

Nos.Working Yes / No


1 Microscope with stage micrometer 20 21 Yes2 Digital Balance 02 2 Yes3 Autoclave 02 2 Yes4 Hot air oven 02 2 Yes


5 B.O.D.incubator 01 1 Yes6 Refrigerator 01 1 Yes7 Laminar air flow 01 1 Yes8 Colony counter 02 2 Yes9 Zone reader 01 1 Yes10 Digital pH meter 01 1 Yes11 Sterility testing unit 01 20 Yes12 Camera Lucida 20 20 Yes13 Eye piece micrometer 20 20 Yes14 Incinerator 01 1 Yes15 Moisture balance 01 1 Yes16 Heating mantle 20 20 Yes17 Flourimeter 01 1 Yes18 Vacuum pump 02 2 Yes19 Micropipettes (Single and multi channeled) 05 5 Yes20 Micro Centrifuge 01 1 Yes21 Projection Microscope 01 1 Yes

Apparatus:


Working Yes / No


1 Reflux flask with condenser 20 20 Yes

2 Water bath 20 20 Yes

3 Clavengers apparatus 10 10 Yes

4 Soxhlet apparatus 10 10 Yes

5 TLC chamber and sprayer 10 10 Yes

6 Distillation unit 01 1 Yes


NOTE: Adequate number of glassware commonly used in the laboratory should be provided in each laboratory and department.

DEPARTMENT OF PHARMACEUTICAL CHEMISTRYEquipment:Sl. No. Name Minimum required Nos. Available



1 Hot plates 05 5 Yes2 Oven 03 3 Yes3 Refrigerator 01 1 Yes4 Analytical Balances for demonstration 05 5 Yes5 Digital balance 10mg sensitivity 10 10 Yes6 Digital Balance (1mg sensitivity) 01 1 Yes7 Suction pumps 06 7 Yes8 Muffle Furnace 01 1 Yes9 Mechanical Stirrers 10 10 Yes10 Magnetic Stirrers with Thermostat 10 10 Yes11 Vacuum Pump 01 1 Yes12 Digital pH meter 01 1 Yes13 Microwave Oven 02 2 Yes

Apparatus:


DEPARTMENT OF PHARMACEUTICS


Working Yes / No


1 Distillation Unit 02 2 Yes2 Reflux flask and condenser single necked 20 20 Yes3 Reflux flask and condenser double / triple

necked20 20 Yes

4 Burettes 100 100 Yes5 Arsenic Limit Test Apparatus 25 25 Yes6 Nesslers Cylinders 50 50 Yes


Equipment:Sl. No. Name Minimum Required

Nos.Available


Remarks ofthe Inspectors

1 Mechanical stirrers 20 20 Yes2 Homogenizer 10 10 Yes3 Digital balance 05 5 Yes4 Microscopes 10 20 Yes5 Stage and eye piece micrometers 15 15 Yes6 Brookfield’s viscometer 01 1 Yes7 Tray dryer 01 1 Yes8 Ball mill 01 1 Yes

9 Sieve shaker with sieve set 01 2 Yes10 Double cone blender 01 1 Yes11 Propeller type mechanical agitator 05 5 Yes12 Autoclave 01 1 Yes13 Steam distillation still 01 1 Yes14 Vacuum Pump 01 1 Yes15 Standard sieves, sieve no. 8, 10, 12,22,24, 44,

66, 8010 sets 10 sets Yes

16 Tablet punching machine 01 1 Yes17 Capsule filling machine 01 1 Yes18 Ampoule washing machine 01 1 Yes19 Ampoule filling and sealing machine 01 1 Yes20 Tablet disintegration test apparatus IP 02 2 Yes21 Tablet dissolution test apparatus IP 01 2 Yes22 Monsanto’s hardness tester 02 2 Yes23 Pfizer type hardness tester 01 1 Yes24 Friability test apparatus 01 2 Yes25 Clarity test apparatus 01 1 Yes26 Ointment filling machine 01 1 Yes27 Collapsible tube crimping machine 01 1 Yes28 Tablet coating pan 01 2 Yes29 Magnetic stirrer, 500ml and 1 liter capacity with speed

control05 EACH

1010 Yes

30 Digital pH meter 01 1 Yes


31 All purpose equipment with all accessories 01 1 Yes32 Aseptic Cabinet 01 1 Yes33 BOD Incubator 02 2 Yes34 Bottle washing Machine 01 1 Yes35 Bottle Sealing Machine 01 1 Yes36 Bulk Density Apparatus 02 2 Yes37 Conical Percolator (glass/ copper/ stainless steel) 10 10 Yes38 Capsule Counter 02 2 Yes39 Energy meter 02 5 Yes40 Hot Plate 02 3 Yes

41 Humidity Control Oven 01 1 Yes42 Liquid Filling Machine 01 1 Yes43 Mechanical stirrer with speed regulator 02 2 Yes44 Precision Melting point Apparatus 01 1 Yes45 Distillation Unit 01 1 Yes

Apparatus:



Working Yes / No


1 Ostwald’s viscometer 20 31 Yes

2 Stalagmometer 20 25 Yes

3 Desiccator* 10 10 Yes

4 Suppository moulds 20 20 Yes

5 Buchner Funnels (Small, medium, large) 05 each 30 Yes

6 Filtration assembly 01 1 Yes

7 Permeability Cups 05 5 Yes

8 Andreason’s Pipette 05 5 Yes

9 Lipstick moulds 10 10 Yes


PHARMACEUTICAL BIOTECHNOLOGYSl. No. Name Minimum required Nos. Available



1 Orbital shaker incubator 01 1 Yes2 Lyophilizer (Desirable) 01 03 Gel Electrophoresis

(Vertical and Horizontal)01 1 Yes

4 Phase contrast/Trinocular Microscope 01 1 Yes5 Refrigerated Centrifuge 01 1 Yes6 Fermenters of different capacity

(Desirable)01 0 Yes

7 Tissue culture station 01 1 Yes8 Laminar airflow unit 01 1 Yes9 Diagnostic kits to identify infectious

agents01 1 Yes

10 Rheometer 01 1 Yes11 Viscometer 01 1 Yes12 Micropipettes (single and multi channeled) 01 each 2 Yes13 Sonicator 01 2 Yes14 Respinometer 01 1 Yes15 BOD Incubator 01 1 Yes16 Paper Electrophoresis Unit 01 1 Yes17 Micro Centrifuge 01 1 Yes18 Incubator water bath 01 1 Yes19 Autoclave 01 1 Yes20 Refrigerator 01 1 Yes21 Filtration Assembly 01 1 Yes22 Digital pH meter 01 1 Yes



CENTRAL INSTRUMENTATION ROOM:

Sl.No.

Name Minimum required Nos. Available Nos.

Working Yes / No


1 Colorimeter 01 1 Yes2 Digital pH meter 01 1 Yes3 UV- Visible Spectrophotometer 01 1 Yes4 Flourimeter 01 1 Yes5 Digital Balance (1mg sensitivity) 01 1 Yes6 Nephelo Turbidity meter 01 1 Yes7 Flame Photometer 01 1 Yes8 Potentiometer 01 1 Yes9 Conductivity meter 01 1 Yes10 Fourier Transform Infra Red Spectrometer (Desirable) 01 0

11 HPLC 01 1 Yes12 HPTLC (Desirable) 01 0


13 Atomic Absorption and Emission spectrophotometer (Desirable) 01 0

14 Biochemistry Analyzer (Desirable) 01 015 Carbon, Hydrogen, Nitrogen Analyzer (Desirable) 01 016 Deep Freezer (Desirable) 01 017 Ion- Exchanger 01 1 Yes18 Lyophilizer (Desirable) 01 0

Observation of the Inspectors:Compliance of the last recommendations by Inspectors

Specific observations if not complied

. Signature of Inspectors: 1

Note:1. The Inspection Team is instructed to physically verify the details and records filled up by the

college in the application form submitted by the college, which is with you now and record the observations, opinions and recommendations in clear and explicit terms.

2. The team is requested to record their comments only after physical verification of records and details.


2

Photograph

PHARMACY COUNCIL OF INDIA

STAFF DECLARATION FORM

From

Teacher’s Name ……………………………………………………… (as on University Degree certificate)

Recent Passport size photo of the Employee Signed by Dean/Principal of the College.

Date of Birth & Age ………………………………………………………

Qualification College & University

Year Registration No. with State Pharmacy

Council

Name of the State Pharmacy Council

B.Pharm

M.Pharm

(Ph.D.)/others

Copies of Registration Certificate and University degree/PG/Ph.D. be attached.

Present Designation :

Department :

College :

City :

Nature of appointment : Permanent/Temporary/Adhoc/Honorary/Part-time

Whether belongs to : O.G./SC/ST/OBC/Ex-service/Others

Contd. on page 2

::2::

Permanent ResidentialAddress of employee : _

Copy of Passport/Voter Card/Ration Card/PAN No./Electricity Bill/Driving License Attached as a proof of residence.

STD Code Phone No.

Phone & Fax Number Office : with Code

Residence :

E-mail address :

Date of joining present institution : as (Designation)

Details of the previous appointments/teaching experience

Position Name of Institution From To Total Experience in years

Lecturer

Reader/ Assistant Professor

Professor

Principal

1) Before joining present institution I was working at as and relieved on after resigning/retiring (relieving order is enclosed from the previous institution).

2) I, hereby undertake that I have not given my name as teaching faculty in any other Pharmacy institution for teaching any Pharmacy course and not working in any where other than this institution Pharmacy College/Medical College/Dental College/Industry/Community Pharmacy/Hospital Pharmacy/Govt. Service/any other service in the State or outside the State in any capacity full-time/part-time other than the above.

Contd. on page 3

::3::

3) I have drawn total emoluments from this college as under (Please fill the data of last academic session) :-

Amount Received TDS

April, 20May, 20June, 20July, 20August, 20September, 20October, 20November, 20December, 20January, 20February, 20March, 20

(Copy of my form 16 (TDS certificate) for the last financial year is attached)

P.A.N. : Circle :

Declaration

1. I have not worked at any other pharmacy college/institution or presented myself at any inspection during my employment in this college.

2. It is declared that each statement and/or contents of this declaration made by the undersigned are absolutely true and correct. In the event of any statement made in this declaration subsequently turning out to be incorrect or false the undersigned has understood and accepted that such misdeclaration in respect to any content of this declaration shall also be treated as a gross misconduct thereby rendering the undersigned liable for necessary disciplinary action (including removal of his name from Register of Registered Pharmacists).

Signature of the Employee:

Date : Place:Endorsement

This endorsement is the certification that the undersigned has satisfied himself/herself about the correctness and veracity of each content of this declaration and endorses the abovementioned declaration as true and correct. In the event of this declaration turning out to be either incorrect or any part of this declaration subsequently turning out to be incorrect or false it is understood and accepted that the undersigned shall also be equally responsible besides the declarant himself/herself for any such misdeclaration or misstatement

Countersigned by the Director/Dean/ Principal in respect of Teaching Staff

Date : Place :

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