PHARMACY COUNCIL OF INDIA

STAFF DECLARATION FORM

From

Teachers Name KB DURGADEVL (as on University Degree certificate)

Recent Passport size photo of the Employee Signed by DeanPrincipal of the College

Date of Birth amp Age 06091991 amp 26

Qualification

BPhaml

College amp University

KMCollege of Pharmacy

amp DrMGR Medical

University

Year

2013

Registration No with State Pharmacy

Name of the State Pharmacy Council

MPharm

Madurai Medical College

amp DrMGR Medical

University

2016

19474 Al Tamil Nadu State Pharmacy Council

(PhD)others I i

Copies of Registration Certificate and University degreePGPhD be attached

Present Designation ~~~~~~~--_________________

Department ~=-==~-=~=L--_________________

College Dhanalakshmi Srinivasan College of Pharmacy

City~~~~~_______~ _____________________________________

Nature of appointment PermanentlTemporarylAdhocHonoraryPart time

Whether belongs to OGlSCSTOBClEx-serviceOthers

Contd on page 2

2

~~~-

Permanent Residential Address of employee 16Agraharam A vaniya Puram

Madura i-625 012

Copy of PassportlVoter CardfRation CardPAN NolElectricity BilllDriving License Attached as a proof of residence

STD Code Phone No

Phone amp Fax Number Office--~~~~---~~~~~~~~~~~-

with Code Residence 8489447172

~~~-~~~~~~~~~~~~--~~-

E-mail addressdurgaamaigmailcom

Date of joining presen t insti tuti on --O-l~O=-8=-=2-=-O~I--7~~__~___as Assistant Professor (Designation)

Details of the previous appointmentsteaching 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 resigningretiring (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 CollegeMedical CollegeDental CollegeIndustryCommunity PharmacyHospital PharmacyGovt Serviceany other service in the State or outside the State in any capacity full-timepart-time other than the above

Contd on page 3

2

~~~-

Permanent Residential Address of employee 16Agraharam A vaniya Puram

Madura i-625 012

Copy of PassportlVoter CardfRation CardPAN NolElectricity BilllDriving License Attached as a proof of residence

STD Code Phone No

Phone amp Fax Number Office--~~~~---~~~~~~~~~~~-

with Code Residence 8489447172

~~~-~~~~~~~~~~~~--~~-

E-mail addressdurgaamaigmailcom

Date of joining presen t insti tuti on --O-l~O=-8=-=2-=-O~I--7~~__~___as Assistant Professor (Designation)

Details of the previous appointmentsteaching 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 resigningretiring (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 CollegeMedical CollegeDental CollegeIndustryCommunity PharmacyHospital PharmacyGovt Serviceany other service in the State or outside the State in any capacity full-timepart-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 oflast academic session) shy

___

TDSAmount Received

April20 May 20

----~----

June 20 July 20 August 20

September 20 October 20 _

November 20 December 20 January 20 February 20 March20

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

PAN ____________ Circle

Declaration

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

2 It is declared that each statement andor contents of thisdeclaration 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 himselfherself 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 middotof 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 himselfherself for any such misdeclaration or misstatement

Coun ircctorDcanl Jrirlcipal in respect of Teaching Staff

Date Place

27072017

DHANALAKAHMI SRINIVASAN COLLEGE OF PHARMACY Thuraiyur Road Perambalur - 621 212

APPOINTMENT ORDER

To

KB Durgadevi

16Agraharam

Avaniya Puram

tv(adurai -6 J 5 (] 12

W-ith references to your resume and based on the interview conducted bv the - ~

selection committee of Dhanalakshmi Srinivasan Charitable and Educational Trust

you are selected as a Assistant Profess-or in our Proposed Dhanalakshmi

Srinivasan College of PharmacyPerambaluJ

Kindly send your willingness to accept the appointment along with 2

photographs and photocopies along with your Original certificates Relieving order

and Experience certificate

You should obey all the rules and regulations of our College of Pharmacy as

per the discussion

JOINING LETTER

From

KB Durgadevi

16Agraharam

Avaniya Puram

Madurai-625 012

To

The Principal

Dhanalakshmi Srinivasan College of Pharmacy

Perambalur - 621212

Respected Sir

Subject KB Durgadevi Joining as Assistant Professor on 01082017 - reg

With reference to the appointment order I am Joining duty as your institution as

Assistant Professor in the Dhanalakshmi Srinivasan College of Pharmacy in the FN of

01082017 Herewith I am submitting my original certificates ID proof and two photographs as

per your instruction for verification r will abide by the rules and regulations of the trust and

College

Thanking YOLl

Place Perambalur

Date

tt ~

shy

rampi 11 e Ir ~

N

cent z u ~

8 r

Ie ~ ~

~

z u o

-------

It NADU PHARMACY CO Cll CHENNAI

PHARMACiST REGISTRATION CERTIFICATE

CERTIFICATE NO 19474 Al DATED 11th March 2014

THIS S TO CERTIFY THAT KB DURGADEVI BPharm

(fMW daughter of KS Baskaran whose date of birth is

6th September 1991 (Nineteenti(inepoundl[ Ol1~ ) has been duly registered as a

REGISTERED PHtARMACIST and is entitled to aI the privileges granted under The Pharmacy Act 1948 (Central Act No VIII of 1948)

as amended to regulate the practice of Pharmacy In the State of Tamil Nadu

IN WITNESS whereof are herewith affixed the seal of the Tamil Nadu Pharmacy Council and

--- f~ gt ~J)i$P1

IIGC1l bull ~~t v ~ -

~~I)~ lI

Note (1) This certificate shall remain in force (2) The above Photograph is due for change on ~

the Signature of the Registrar of the said Pharmacy Council

ft$~~ _~~OI- w ~

J

K13~uUl~o ~~L Signature of t~e Candidate

1110312019 grace upto

lt

f

FORM -I [See Rule 79 (2)]

Registration of Additional Qualification (Under Section 35 of the Pharmacy Act1948)

(Yfw a-rilliU(JIl(li dilioIUlf 1 6lYliffieat(J d~Jff(]e

ajllteatlllf h(doU) W~middot hef11J ifW(JUed ill llt(l

CfiJieffi9telf 01 (7JiAaUfMwiAl4 flIt tll C(5flil (ftadll JtoJe

arailUlt th~ nflneol th~ illowil1fj cleflirjlet(uj C(PhJUluwi4t

Name KB DURGADEVI

Registrttion Number amp Date

DiplOlnalCeltificateDegree ai1eady registered

DiplomaCertifica teDegree MPbarm now registered (PHARft1ACEl1TlCAL CHEMISTRY)

Date of Addl Qualification Regd 30032017

$lgnature6f tl)e Candidate middotMA~middot ~Ygt- -~ bull_~_bull -~-A-~~ _clt bullbullbull - bullbull) __ - ~

u

cu rdrr t CERTIFICATE S No SEC 43518 31 i91118iji) il6IDIDGU6lnmli1ifeoo 000

OEARiMENT OFGOVERNlvleNTEx~MINATla~J5 cliENNAI-600 oQGmiddotmiddot

middotmiddotWmiddotmiddot6ampJL q Ultirff~~~~middot fh

rfl-gtmiddot~60U u6iramprfl~~I~middotmiddotmiddotmiddot6tJ( gt _ -~Jl lt ~ ~ ~ ~~~ ~

$E$QNOARY SCHOO MING CERTlft(jATE~

LUL 6)l~ffiJ~UW(11~D~ lt) tTunT (JF THE GOVERNMENfOFTA~lIiNAOU-~-

bullj - ~ shy ~ bull

DURGADEVI

t B QI)WLjU QLHrsectJ~j CpiirQeuroU(Yitpoundl

Ltl~lqGluoomG1ieurontl GJuri)IDlciTrorr rT GnJil1l111 lHfEil5TfDeuroll)8ioaHJ (blqgt) WJ

i~riffied that tire above mentioned candldatl3 appeared for tfle SSLC PubilcExamfnatfon and h rained theaf marks

tpound~tblildlru til ( ENGLISH

83 EIGHT THREE

81

88

67

88 EIGHT EIGHT

407 FOUR ZERO

~~ L~lflJ$bfb JDfrlgt1r I DATE OF I3IHTH Li tl~igtlflfaIH I HEGISrEH NO LClttlJJ (aIDlu11_~Lm(IJr~n t TMR CODE NO ADATE

180653 A166000 3105200706091991

I NAME OF THE SCHOOL

SOLJRASHTRA G HSS MADURAl

hID~L~raquoil)U UG1t~ ~IDI[i) filJfjuLu GlurriJ$f 1l)lilimlJdl tl)lillgm (lulU 9GiJGlQJfTjUI1LJgtJJ5IJW lOOurj~ ~l)lUl ~JQril (ljluufi~~tfCJUljlUGlU8i~ (JuglJ$5~ GiiiUtifflID (ID~ ueji) (YlraquoLluJi) tlflSqWlJ Iff(tpji)ib OJ5ITltJii G1ulJJraquoiJf5U)W QUI1(sectbiiiw APass ifll11ft sslc Examination requires a minimum of TlIIrty Five pefont of marks In oach subject Tlris InclUdes passing undef tbe Compartmental System

27072017

DHANALAKAHMI SRINIVASAN COLLEGE OF PHARMACY Thuraiyur Road Perambalur - 621 212

APPOINTMENT ORDER

To

KB Durgadevi

16Agraharam

Avaniya Puram

tv(adurai -6 J 5 (] 12

W-ith references to your resume and based on the interview conducted bv the - ~

selection committee of Dhanalakshmi Srinivasan Charitable and Educational Trust

you are selected as a Assistant Profess-or in our Proposed Dhanalakshmi

Srinivasan College of PharmacyPerambaluJ

Kindly send your willingness to accept the appointment along with 2

photographs and photocopies along with your Original certificates Relieving order

and Experience certificate

You should obey all the rules and regulations of our College of Pharmacy as

per the discussion

JOINING LETTER

From

KB Durgadevi

16Agraharam

Avaniya Puram

Madurai-625 012

To

The Principal

Dhanalakshmi Srinivasan College of Pharmacy

Perambalur - 621212

Respected Sir

Subject KB Durgadevi Joining as Assistant Professor on 01082017 - reg

With reference to the appointment order I am Joining duty as your institution as

Assistant Professor in the Dhanalakshmi Srinivasan College of Pharmacy in the FN of

01082017 Herewith I am submitting my original certificates ID proof and two photographs as

per your instruction for verification r will abide by the rules and regulations of the trust and

College

Thanking YOLl

Place Perambalur

Date

tt ~

shy

rampi 11 e Ir ~

N

cent z u ~

8 r

Ie ~ ~

~

z u o

-------

It NADU PHARMACY CO Cll CHENNAI

PHARMACiST REGISTRATION CERTIFICATE

CERTIFICATE NO 19474 Al DATED 11th March 2014

THIS S TO CERTIFY THAT KB DURGADEVI BPharm

(fMW daughter of KS Baskaran whose date of birth is

6th September 1991 (Nineteenti(inepoundl[ Ol1~ ) has been duly registered as a

REGISTERED PHtARMACIST and is entitled to aI the privileges granted under The Pharmacy Act 1948 (Central Act No VIII of 1948)

as amended to regulate the practice of Pharmacy In the State of Tamil Nadu

IN WITNESS whereof are herewith affixed the seal of the Tamil Nadu Pharmacy Council and

--- f~ gt ~J)i$P1

IIGC1l bull ~~t v ~ -

~~I)~ lI

Note (1) This certificate shall remain in force (2) The above Photograph is due for change on ~

the Signature of the Registrar of the said Pharmacy Council

ft$~~ _~~OI- w ~

J

K13~uUl~o ~~L Signature of t~e Candidate

1110312019 grace upto

lt

f

FORM -I [See Rule 79 (2)]

Registration of Additional Qualification (Under Section 35 of the Pharmacy Act1948)

(Yfw a-rilliU(JIl(li dilioIUlf 1 6lYliffieat(J d~Jff(]e

ajllteatlllf h(doU) W~middot hef11J ifW(JUed ill llt(l

CfiJieffi9telf 01 (7JiAaUfMwiAl4 flIt tll C(5flil (ftadll JtoJe

arailUlt th~ nflneol th~ illowil1fj cleflirjlet(uj C(PhJUluwi4t

Name KB DURGADEVI

Registrttion Number amp Date

DiplOlnalCeltificateDegree ai1eady registered

DiplomaCertifica teDegree MPbarm now registered (PHARft1ACEl1TlCAL CHEMISTRY)

Date of Addl Qualification Regd 30032017

$lgnature6f tl)e Candidate middotMA~middot ~Ygt- -~ bull_~_bull -~-A-~~ _clt bullbullbull - bullbull) __ - ~

u

cu rdrr t CERTIFICATE S No SEC 43518 31 i91118iji) il6IDIDGU6lnmli1ifeoo 000

OEARiMENT OFGOVERNlvleNTEx~MINATla~J5 cliENNAI-600 oQGmiddotmiddot

middotmiddotWmiddotmiddot6ampJL q Ultirff~~~~middot fh

rfl-gtmiddot~60U u6iramprfl~~I~middotmiddotmiddotmiddot6tJ( gt _ -~Jl lt ~ ~ ~ ~~~ ~

$E$QNOARY SCHOO MING CERTlft(jATE~

LUL 6)l~ffiJ~UW(11~D~ lt) tTunT (JF THE GOVERNMENfOFTA~lIiNAOU-~-

bullj - ~ shy ~ bull

DURGADEVI

t B QI)WLjU QLHrsectJ~j CpiirQeuroU(Yitpoundl

Ltl~lqGluoomG1ieurontl GJuri)IDlciTrorr rT GnJil1l111 lHfEil5TfDeuroll)8ioaHJ (blqgt) WJ

i~riffied that tire above mentioned candldatl3 appeared for tfle SSLC PubilcExamfnatfon and h rained theaf marks

tpound~tblildlru til ( ENGLISH

83 EIGHT THREE

81

88

67

88 EIGHT EIGHT

407 FOUR ZERO

~~ L~lflJ$bfb JDfrlgt1r I DATE OF I3IHTH Li tl~igtlflfaIH I HEGISrEH NO LClttlJJ (aIDlu11_~Lm(IJr~n t TMR CODE NO ADATE

180653 A166000 3105200706091991

I NAME OF THE SCHOOL

SOLJRASHTRA G HSS MADURAl

hID~L~raquoil)U UG1t~ ~IDI[i) filJfjuLu GlurriJ$f 1l)lilimlJdl tl)lillgm (lulU 9GiJGlQJfTjUI1LJgtJJ5IJW lOOurj~ ~l)lUl ~JQril (ljluufi~~tfCJUljlUGlU8i~ (JuglJ$5~ GiiiUtifflID (ID~ ueji) (YlraquoLluJi) tlflSqWlJ Iff(tpji)ib OJ5ITltJii G1ulJJraquoiJf5U)W QUI1(sectbiiiw APass ifll11ft sslc Examination requires a minimum of TlIIrty Five pefont of marks In oach subject Tlris InclUdes passing undef tbe Compartmental System

JOINING LETTER

From

KB Durgadevi

16Agraharam

Avaniya Puram

Madurai-625 012

To

The Principal

Dhanalakshmi Srinivasan College of Pharmacy

Perambalur - 621212

Respected Sir

Subject KB Durgadevi Joining as Assistant Professor on 01082017 - reg

With reference to the appointment order I am Joining duty as your institution as

Assistant Professor in the Dhanalakshmi Srinivasan College of Pharmacy in the FN of

01082017 Herewith I am submitting my original certificates ID proof and two photographs as

per your instruction for verification r will abide by the rules and regulations of the trust and

College

Thanking YOLl

Place Perambalur

Date

tt ~

shy

rampi 11 e Ir ~

N

cent z u ~

8 r

Ie ~ ~

~

z u o

-------

It NADU PHARMACY CO Cll CHENNAI

PHARMACiST REGISTRATION CERTIFICATE

CERTIFICATE NO 19474 Al DATED 11th March 2014

THIS S TO CERTIFY THAT KB DURGADEVI BPharm

(fMW daughter of KS Baskaran whose date of birth is

6th September 1991 (Nineteenti(inepoundl[ Ol1~ ) has been duly registered as a

REGISTERED PHtARMACIST and is entitled to aI the privileges granted under The Pharmacy Act 1948 (Central Act No VIII of 1948)

as amended to regulate the practice of Pharmacy In the State of Tamil Nadu

IN WITNESS whereof are herewith affixed the seal of the Tamil Nadu Pharmacy Council and

--- f~ gt ~J)i$P1

IIGC1l bull ~~t v ~ -

~~I)~ lI

Note (1) This certificate shall remain in force (2) The above Photograph is due for change on ~

the Signature of the Registrar of the said Pharmacy Council

ft$~~ _~~OI- w ~

J

K13~uUl~o ~~L Signature of t~e Candidate

1110312019 grace upto

lt

f

FORM -I [See Rule 79 (2)]

Registration of Additional Qualification (Under Section 35 of the Pharmacy Act1948)

(Yfw a-rilliU(JIl(li dilioIUlf 1 6lYliffieat(J d~Jff(]e

ajllteatlllf h(doU) W~middot hef11J ifW(JUed ill llt(l

CfiJieffi9telf 01 (7JiAaUfMwiAl4 flIt tll C(5flil (ftadll JtoJe

arailUlt th~ nflneol th~ illowil1fj cleflirjlet(uj C(PhJUluwi4t

Name KB DURGADEVI

Registrttion Number amp Date

DiplOlnalCeltificateDegree ai1eady registered

DiplomaCertifica teDegree MPbarm now registered (PHARft1ACEl1TlCAL CHEMISTRY)

Date of Addl Qualification Regd 30032017

$lgnature6f tl)e Candidate middotMA~middot ~Ygt- -~ bull_~_bull -~-A-~~ _clt bullbullbull - bullbull) __ - ~

u

cu rdrr t CERTIFICATE S No SEC 43518 31 i91118iji) il6IDIDGU6lnmli1ifeoo 000

OEARiMENT OFGOVERNlvleNTEx~MINATla~J5 cliENNAI-600 oQGmiddotmiddot

middotmiddotWmiddotmiddot6ampJL q Ultirff~~~~middot fh

rfl-gtmiddot~60U u6iramprfl~~I~middotmiddotmiddotmiddot6tJ( gt _ -~Jl lt ~ ~ ~ ~~~ ~

$E$QNOARY SCHOO MING CERTlft(jATE~

LUL 6)l~ffiJ~UW(11~D~ lt) tTunT (JF THE GOVERNMENfOFTA~lIiNAOU-~-

bullj - ~ shy ~ bull

DURGADEVI

t B QI)WLjU QLHrsectJ~j CpiirQeuroU(Yitpoundl

Ltl~lqGluoomG1ieurontl GJuri)IDlciTrorr rT GnJil1l111 lHfEil5TfDeuroll)8ioaHJ (blqgt) WJ

i~riffied that tire above mentioned candldatl3 appeared for tfle SSLC PubilcExamfnatfon and h rained theaf marks

tpound~tblildlru til ( ENGLISH

83 EIGHT THREE

81

88

67

88 EIGHT EIGHT

407 FOUR ZERO

~~ L~lflJ$bfb JDfrlgt1r I DATE OF I3IHTH Li tl~igtlflfaIH I HEGISrEH NO LClttlJJ (aIDlu11_~Lm(IJr~n t TMR CODE NO ADATE

180653 A166000 3105200706091991

I NAME OF THE SCHOOL

SOLJRASHTRA G HSS MADURAl

hID~L~raquoil)U UG1t~ ~IDI[i) filJfjuLu GlurriJ$f 1l)lilimlJdl tl)lillgm (lulU 9GiJGlQJfTjUI1LJgtJJ5IJW lOOurj~ ~l)lUl ~JQril (ljluufi~~tfCJUljlUGlU8i~ (JuglJ$5~ GiiiUtifflID (ID~ ueji) (YlraquoLluJi) tlflSqWlJ Iff(tpji)ib OJ5ITltJii G1ulJJraquoiJf5U)W QUI1(sectbiiiw APass ifll11ft sslc Examination requires a minimum of TlIIrty Five pefont of marks In oach subject Tlris InclUdes passing undef tbe Compartmental System

tt ~

shy

rampi 11 e Ir ~

N

cent z u ~

8 r

Ie ~ ~

~

z u o

-------

It NADU PHARMACY CO Cll CHENNAI

PHARMACiST REGISTRATION CERTIFICATE

CERTIFICATE NO 19474 Al DATED 11th March 2014

THIS S TO CERTIFY THAT KB DURGADEVI BPharm

(fMW daughter of KS Baskaran whose date of birth is

6th September 1991 (Nineteenti(inepoundl[ Ol1~ ) has been duly registered as a

REGISTERED PHtARMACIST and is entitled to aI the privileges granted under The Pharmacy Act 1948 (Central Act No VIII of 1948)

as amended to regulate the practice of Pharmacy In the State of Tamil Nadu

IN WITNESS whereof are herewith affixed the seal of the Tamil Nadu Pharmacy Council and

--- f~ gt ~J)i$P1

IIGC1l bull ~~t v ~ -

~~I)~ lI

Note (1) This certificate shall remain in force (2) The above Photograph is due for change on ~

the Signature of the Registrar of the said Pharmacy Council

ft$~~ _~~OI- w ~

J

K13~uUl~o ~~L Signature of t~e Candidate

1110312019 grace upto

lt

f

FORM -I [See Rule 79 (2)]

Registration of Additional Qualification (Under Section 35 of the Pharmacy Act1948)

(Yfw a-rilliU(JIl(li dilioIUlf 1 6lYliffieat(J d~Jff(]e

ajllteatlllf h(doU) W~middot hef11J ifW(JUed ill llt(l

CfiJieffi9telf 01 (7JiAaUfMwiAl4 flIt tll C(5flil (ftadll JtoJe

arailUlt th~ nflneol th~ illowil1fj cleflirjlet(uj C(PhJUluwi4t

Name KB DURGADEVI

Registrttion Number amp Date

DiplOlnalCeltificateDegree ai1eady registered

DiplomaCertifica teDegree MPbarm now registered (PHARft1ACEl1TlCAL CHEMISTRY)

Date of Addl Qualification Regd 30032017

$lgnature6f tl)e Candidate middotMA~middot ~Ygt- -~ bull_~_bull -~-A-~~ _clt bullbullbull - bullbull) __ - ~

u

cu rdrr t CERTIFICATE S No SEC 43518 31 i91118iji) il6IDIDGU6lnmli1ifeoo 000

OEARiMENT OFGOVERNlvleNTEx~MINATla~J5 cliENNAI-600 oQGmiddotmiddot

middotmiddotWmiddotmiddot6ampJL q Ultirff~~~~middot fh

rfl-gtmiddot~60U u6iramprfl~~I~middotmiddotmiddotmiddot6tJ( gt _ -~Jl lt ~ ~ ~ ~~~ ~

$E$QNOARY SCHOO MING CERTlft(jATE~

LUL 6)l~ffiJ~UW(11~D~ lt) tTunT (JF THE GOVERNMENfOFTA~lIiNAOU-~-

bullj - ~ shy ~ bull

DURGADEVI

t B QI)WLjU QLHrsectJ~j CpiirQeuroU(Yitpoundl

Ltl~lqGluoomG1ieurontl GJuri)IDlciTrorr rT GnJil1l111 lHfEil5TfDeuroll)8ioaHJ (blqgt) WJ

i~riffied that tire above mentioned candldatl3 appeared for tfle SSLC PubilcExamfnatfon and h rained theaf marks

tpound~tblildlru til ( ENGLISH

83 EIGHT THREE

81

88

67

88 EIGHT EIGHT

407 FOUR ZERO

~~ L~lflJ$bfb JDfrlgt1r I DATE OF I3IHTH Li tl~igtlflfaIH I HEGISrEH NO LClttlJJ (aIDlu11_~Lm(IJr~n t TMR CODE NO ADATE

180653 A166000 3105200706091991

I NAME OF THE SCHOOL

SOLJRASHTRA G HSS MADURAl

hID~L~raquoil)U UG1t~ ~IDI[i) filJfjuLu GlurriJ$f 1l)lilimlJdl tl)lillgm (lulU 9GiJGlQJfTjUI1LJgtJJ5IJW lOOurj~ ~l)lUl ~JQril (ljluufi~~tfCJUljlUGlU8i~ (JuglJ$5~ GiiiUtifflID (ID~ ueji) (YlraquoLluJi) tlflSqWlJ Iff(tpji)ib OJ5ITltJii G1ulJJraquoiJf5U)W QUI1(sectbiiiw APass ifll11ft sslc Examination requires a minimum of TlIIrty Five pefont of marks In oach subject Tlris InclUdes passing undef tbe Compartmental System

~

z u o

-------

It NADU PHARMACY CO Cll CHENNAI

PHARMACiST REGISTRATION CERTIFICATE

CERTIFICATE NO 19474 Al DATED 11th March 2014

THIS S TO CERTIFY THAT KB DURGADEVI BPharm

(fMW daughter of KS Baskaran whose date of birth is

6th September 1991 (Nineteenti(inepoundl[ Ol1~ ) has been duly registered as a

REGISTERED PHtARMACIST and is entitled to aI the privileges granted under The Pharmacy Act 1948 (Central Act No VIII of 1948)

as amended to regulate the practice of Pharmacy In the State of Tamil Nadu

IN WITNESS whereof are herewith affixed the seal of the Tamil Nadu Pharmacy Council and

--- f~ gt ~J)i$P1

IIGC1l bull ~~t v ~ -

~~I)~ lI

Note (1) This certificate shall remain in force (2) The above Photograph is due for change on ~

the Signature of the Registrar of the said Pharmacy Council

ft$~~ _~~OI- w ~

J

K13~uUl~o ~~L Signature of t~e Candidate

1110312019 grace upto

lt

f

FORM -I [See Rule 79 (2)]

Registration of Additional Qualification (Under Section 35 of the Pharmacy Act1948)

(Yfw a-rilliU(JIl(li dilioIUlf 1 6lYliffieat(J d~Jff(]e

ajllteatlllf h(doU) W~middot hef11J ifW(JUed ill llt(l

CfiJieffi9telf 01 (7JiAaUfMwiAl4 flIt tll C(5flil (ftadll JtoJe

arailUlt th~ nflneol th~ illowil1fj cleflirjlet(uj C(PhJUluwi4t

Name KB DURGADEVI

Registrttion Number amp Date

DiplOlnalCeltificateDegree ai1eady registered

DiplomaCertifica teDegree MPbarm now registered (PHARft1ACEl1TlCAL CHEMISTRY)

Date of Addl Qualification Regd 30032017

$lgnature6f tl)e Candidate middotMA~middot ~Ygt- -~ bull_~_bull -~-A-~~ _clt bullbullbull - bullbull) __ - ~

u

cu rdrr t CERTIFICATE S No SEC 43518 31 i91118iji) il6IDIDGU6lnmli1ifeoo 000

OEARiMENT OFGOVERNlvleNTEx~MINATla~J5 cliENNAI-600 oQGmiddotmiddot

middotmiddotWmiddotmiddot6ampJL q Ultirff~~~~middot fh

rfl-gtmiddot~60U u6iramprfl~~I~middotmiddotmiddotmiddot6tJ( gt _ -~Jl lt ~ ~ ~ ~~~ ~

$E$QNOARY SCHOO MING CERTlft(jATE~

LUL 6)l~ffiJ~UW(11~D~ lt) tTunT (JF THE GOVERNMENfOFTA~lIiNAOU-~-

bullj - ~ shy ~ bull

DURGADEVI

t B QI)WLjU QLHrsectJ~j CpiirQeuroU(Yitpoundl

Ltl~lqGluoomG1ieurontl GJuri)IDlciTrorr rT GnJil1l111 lHfEil5TfDeuroll)8ioaHJ (blqgt) WJ

i~riffied that tire above mentioned candldatl3 appeared for tfle SSLC PubilcExamfnatfon and h rained theaf marks

tpound~tblildlru til ( ENGLISH

83 EIGHT THREE

81

88

67

88 EIGHT EIGHT

407 FOUR ZERO

~~ L~lflJ$bfb JDfrlgt1r I DATE OF I3IHTH Li tl~igtlflfaIH I HEGISrEH NO LClttlJJ (aIDlu11_~Lm(IJr~n t TMR CODE NO ADATE

180653 A166000 3105200706091991

I NAME OF THE SCHOOL

SOLJRASHTRA G HSS MADURAl

hID~L~raquoil)U UG1t~ ~IDI[i) filJfjuLu GlurriJ$f 1l)lilimlJdl tl)lillgm (lulU 9GiJGlQJfTjUI1LJgtJJ5IJW lOOurj~ ~l)lUl ~JQril (ljluufi~~tfCJUljlUGlU8i~ (JuglJ$5~ GiiiUtifflID (ID~ ueji) (YlraquoLluJi) tlflSqWlJ Iff(tpji)ib OJ5ITltJii G1ulJJraquoiJf5U)W QUI1(sectbiiiw APass ifll11ft sslc Examination requires a minimum of TlIIrty Five pefont of marks In oach subject Tlris InclUdes passing undef tbe Compartmental System

-------

It NADU PHARMACY CO Cll CHENNAI

PHARMACiST REGISTRATION CERTIFICATE

CERTIFICATE NO 19474 Al DATED 11th March 2014

THIS S TO CERTIFY THAT KB DURGADEVI BPharm

(fMW daughter of KS Baskaran whose date of birth is

6th September 1991 (Nineteenti(inepoundl[ Ol1~ ) has been duly registered as a

REGISTERED PHtARMACIST and is entitled to aI the privileges granted under The Pharmacy Act 1948 (Central Act No VIII of 1948)

as amended to regulate the practice of Pharmacy In the State of Tamil Nadu

IN WITNESS whereof are herewith affixed the seal of the Tamil Nadu Pharmacy Council and

--- f~ gt ~J)i$P1

IIGC1l bull ~~t v ~ -

~~I)~ lI

Note (1) This certificate shall remain in force (2) The above Photograph is due for change on ~

the Signature of the Registrar of the said Pharmacy Council

ft$~~ _~~OI- w ~

J

K13~uUl~o ~~L Signature of t~e Candidate

1110312019 grace upto

lt

f

FORM -I [See Rule 79 (2)]

Registration of Additional Qualification (Under Section 35 of the Pharmacy Act1948)

(Yfw a-rilliU(JIl(li dilioIUlf 1 6lYliffieat(J d~Jff(]e

ajllteatlllf h(doU) W~middot hef11J ifW(JUed ill llt(l

CfiJieffi9telf 01 (7JiAaUfMwiAl4 flIt tll C(5flil (ftadll JtoJe

arailUlt th~ nflneol th~ illowil1fj cleflirjlet(uj C(PhJUluwi4t

Name KB DURGADEVI

Registrttion Number amp Date

DiplOlnalCeltificateDegree ai1eady registered

DiplomaCertifica teDegree MPbarm now registered (PHARft1ACEl1TlCAL CHEMISTRY)

Date of Addl Qualification Regd 30032017

$lgnature6f tl)e Candidate middotMA~middot ~Ygt- -~ bull_~_bull -~-A-~~ _clt bullbullbull - bullbull) __ - ~

u

cu rdrr t CERTIFICATE S No SEC 43518 31 i91118iji) il6IDIDGU6lnmli1ifeoo 000

OEARiMENT OFGOVERNlvleNTEx~MINATla~J5 cliENNAI-600 oQGmiddotmiddot

middotmiddotWmiddotmiddot6ampJL q Ultirff~~~~middot fh

rfl-gtmiddot~60U u6iramprfl~~I~middotmiddotmiddotmiddot6tJ( gt _ -~Jl lt ~ ~ ~ ~~~ ~

$E$QNOARY SCHOO MING CERTlft(jATE~

LUL 6)l~ffiJ~UW(11~D~ lt) tTunT (JF THE GOVERNMENfOFTA~lIiNAOU-~-

bullj - ~ shy ~ bull

DURGADEVI

t B QI)WLjU QLHrsectJ~j CpiirQeuroU(Yitpoundl

Ltl~lqGluoomG1ieurontl GJuri)IDlciTrorr rT GnJil1l111 lHfEil5TfDeuroll)8ioaHJ (blqgt) WJ

i~riffied that tire above mentioned candldatl3 appeared for tfle SSLC PubilcExamfnatfon and h rained theaf marks

tpound~tblildlru til ( ENGLISH

83 EIGHT THREE

81

88

67

88 EIGHT EIGHT

407 FOUR ZERO

~~ L~lflJ$bfb JDfrlgt1r I DATE OF I3IHTH Li tl~igtlflfaIH I HEGISrEH NO LClttlJJ (aIDlu11_~Lm(IJr~n t TMR CODE NO ADATE

180653 A166000 3105200706091991

I NAME OF THE SCHOOL

SOLJRASHTRA G HSS MADURAl

hID~L~raquoil)U UG1t~ ~IDI[i) filJfjuLu GlurriJ$f 1l)lilimlJdl tl)lillgm (lulU 9GiJGlQJfTjUI1LJgtJJ5IJW lOOurj~ ~l)lUl ~JQril (ljluufi~~tfCJUljlUGlU8i~ (JuglJ$5~ GiiiUtifflID (ID~ ueji) (YlraquoLluJi) tlflSqWlJ Iff(tpji)ib OJ5ITltJii G1ulJJraquoiJf5U)W QUI1(sectbiiiw APass ifll11ft sslc Examination requires a minimum of TlIIrty Five pefont of marks In oach subject Tlris InclUdes passing undef tbe Compartmental System

FORM -I [See Rule 79 (2)]

Registration of Additional Qualification (Under Section 35 of the Pharmacy Act1948)

(Yfw a-rilliU(JIl(li dilioIUlf 1 6lYliffieat(J d~Jff(]e

ajllteatlllf h(doU) W~middot hef11J ifW(JUed ill llt(l

CfiJieffi9telf 01 (7JiAaUfMwiAl4 flIt tll C(5flil (ftadll JtoJe

arailUlt th~ nflneol th~ illowil1fj cleflirjlet(uj C(PhJUluwi4t

Name KB DURGADEVI

Registrttion Number amp Date

DiplOlnalCeltificateDegree ai1eady registered

DiplomaCertifica teDegree MPbarm now registered (PHARft1ACEl1TlCAL CHEMISTRY)

Date of Addl Qualification Regd 30032017

$lgnature6f tl)e Candidate middotMA~middot ~Ygt- -~ bull_~_bull -~-A-~~ _clt bullbullbull - bullbull) __ - ~

u

cu rdrr t CERTIFICATE S No SEC 43518 31 i91118iji) il6IDIDGU6lnmli1ifeoo 000

OEARiMENT OFGOVERNlvleNTEx~MINATla~J5 cliENNAI-600 oQGmiddotmiddot

middotmiddotWmiddotmiddot6ampJL q Ultirff~~~~middot fh

rfl-gtmiddot~60U u6iramprfl~~I~middotmiddotmiddotmiddot6tJ( gt _ -~Jl lt ~ ~ ~ ~~~ ~

$E$QNOARY SCHOO MING CERTlft(jATE~

LUL 6)l~ffiJ~UW(11~D~ lt) tTunT (JF THE GOVERNMENfOFTA~lIiNAOU-~-

bullj - ~ shy ~ bull

DURGADEVI

t B QI)WLjU QLHrsectJ~j CpiirQeuroU(Yitpoundl

Ltl~lqGluoomG1ieurontl GJuri)IDlciTrorr rT GnJil1l111 lHfEil5TfDeuroll)8ioaHJ (blqgt) WJ

i~riffied that tire above mentioned candldatl3 appeared for tfle SSLC PubilcExamfnatfon and h rained theaf marks

tpound~tblildlru til ( ENGLISH

83 EIGHT THREE

81

88

67

88 EIGHT EIGHT

407 FOUR ZERO

~~ L~lflJ$bfb JDfrlgt1r I DATE OF I3IHTH Li tl~igtlflfaIH I HEGISrEH NO LClttlJJ (aIDlu11_~Lm(IJr~n t TMR CODE NO ADATE

180653 A166000 3105200706091991

I NAME OF THE SCHOOL

SOLJRASHTRA G HSS MADURAl

hID~L~raquoil)U UG1t~ ~IDI[i) filJfjuLu GlurriJ$f 1l)lilimlJdl tl)lillgm (lulU 9GiJGlQJfTjUI1LJgtJJ5IJW lOOurj~ ~l)lUl ~JQril (ljluufi~~tfCJUljlUGlU8i~ (JuglJ$5~ GiiiUtifflID (ID~ ueji) (YlraquoLluJi) tlflSqWlJ Iff(tpji)ib OJ5ITltJii G1ulJJraquoiJf5U)W QUI1(sectbiiiw APass ifll11ft sslc Examination requires a minimum of TlIIrty Five pefont of marks In oach subject Tlris InclUdes passing undef tbe Compartmental System

u

cu rdrr t CERTIFICATE S No SEC 43518 31 i91118iji) il6IDIDGU6lnmli1ifeoo 000

OEARiMENT OFGOVERNlvleNTEx~MINATla~J5 cliENNAI-600 oQGmiddotmiddot

middotmiddotWmiddotmiddot6ampJL q Ultirff~~~~middot fh

rfl-gtmiddot~60U u6iramprfl~~I~middotmiddotmiddotmiddot6tJ( gt _ -~Jl lt ~ ~ ~ ~~~ ~

$E$QNOARY SCHOO MING CERTlft(jATE~

LUL 6)l~ffiJ~UW(11~D~ lt) tTunT (JF THE GOVERNMENfOFTA~lIiNAOU-~-

bullj - ~ shy ~ bull

DURGADEVI

t B QI)WLjU QLHrsectJ~j CpiirQeuroU(Yitpoundl

Ltl~lqGluoomG1ieurontl GJuri)IDlciTrorr rT GnJil1l111 lHfEil5TfDeuroll)8ioaHJ (blqgt) WJ

i~riffied that tire above mentioned candldatl3 appeared for tfle SSLC PubilcExamfnatfon and h rained theaf marks

tpound~tblildlru til ( ENGLISH

83 EIGHT THREE

81

88

67

88 EIGHT EIGHT

407 FOUR ZERO

~~ L~lflJ$bfb JDfrlgt1r I DATE OF I3IHTH Li tl~igtlflfaIH I HEGISrEH NO LClttlJJ (aIDlu11_~Lm(IJr~n t TMR CODE NO ADATE

180653 A166000 3105200706091991

I NAME OF THE SCHOOL

SOLJRASHTRA G HSS MADURAl

hID~L~raquoil)U UG1t~ ~IDI[i) filJfjuLu GlurriJ$f 1l)lilimlJdl tl)lillgm (lulU 9GiJGlQJfTjUI1LJgtJJ5IJW lOOurj~ ~l)lUl ~JQril (ljluufi~~tfCJUljlUGlU8i~ (JuglJ$5~ GiiiUtifflID (ID~ ueji) (YlraquoLluJi) tlflSqWlJ Iff(tpji)ib OJ5ITltJii G1ulJJraquoiJf5U)W QUI1(sectbiiiw APass ifll11ft sslc Examination requires a minimum of TlIIrty Five pefont of marks In oach subject Tlris InclUdes passing undef tbe Compartmental System

To ~iJBrrti6lll tlt6 Ul Durgadevi K B

010 Baskaran ltgt o 16 AGRAHARAM ~ AVANIYAPURAM Avaniapuram

ltgt Avanivpuram Madura South Madurai

1 Tamil Naclu 625012 S9344107392

E1IIIIIIIIIIIIIIIllnllllUIIlIIIIU 11111 ~ ML013938343FT

~rfu8)6lT ~$DlTIj 6T6lfirr I YourAadhaar No

9101 6291 4444 ~lJrrg - lfrr$blT~mT w6nft$b6nft6ir ~h1ampITI]Lb

------------------------ ---- --- ------ ------x-~~~~ ~~~_ral~j ~1j8irraDiDl taUl Durgadevi K B

iblm)ll urrwalJriT Father Baskaran UliDbi lblT6ir I DOB Q6091991

Qu61i1JUITOO I Female

9101 6291 4444