Retail Chemist & Druggist Association

SECTION I: MEMBER CONTACT INFORMATION

Contact No.

Verify contact for RCDA Membership No

RCDA Membership No.

If You are Not RCDA Member

Name

Medical Name

Address

Registration Place

Pin Code

SECTION II: OTHER INFORMATION

QUALIFICATION

Experience

DL No. 1

DL No. 2

DL No. 3

DL Lic. Photo

Upload PAN Card

Other Business

Last Six month Bank Statement

Passport Photo(front Facing)

Upload Adhar Card

Front:

Back:

Agreed to follow all rules regulations set by RCDA time to time.