THE AMENDED PHARMACY ACT. 
577 
practitioners at 
the day of 
Dated this day of 
, in the county of 
, 186 . 
Signed (Name.) 
, 18 . 
, on or before 
SCHEDULE D. 
Declaration to be signed by a duly quedijied Medical Practitioner , or Magistrate, 
respecting a person who teas in business as a Chemist and Druggist in Great 
Britain before the Pharmacy Act , 1868. 
To the Registrar of the Pharmaceutical Society of Great Britain. 
I residing at , in the county of , 
hereby declare that I am a duly qualified Medical Practitioner [or Magistrate], 
and that to my knowledge , residing at in the 
county of , was in business as a Chemist and Druggist, in the 
keeping of open shop for the compounding of the prescriptions of duly qualified 
Medical Practitioners, before the day of , 186 . 
(. Signed) 
SCHEDULE E. 
Declarations to be signed by and on behalf of any Apprentice or Assistant claiming 
to be registered under the Pharmacy Act , 1868. 
To the Registrar of the Pharmaceutical Society of Great Britain. 
I hereby declare that the undersigned , residing at 
, in the county of , had before the passing 
of the Pharmacy Act, 1868, been employed in dispensing and compounding 
prescriptions, as an Assistant to a Pharmaceutical Chemist or Chemist and 
Druggist, and attained the age of twenty-one years [or had been apprenticed to 
a Pharmaceutical Chemist or Chemist and Druggist, keeping open shop for the 
compounding of prescriptions of duly qualified medical men]. 
As witness my hand, this day of 186 . 
A. B., duly qualified Medical Practitioner. 
C. D., Pharmaceutical Chemist. 
E. F., Chemist and Druggist. 
G. H., Magistrate. 
(To be signed by one of the four parties named.) 
I hereby declare that I was an Apprentice to 
in the county of in the year 
of 
L. iff., Apprentice. 
I hereby declare that I was an Assistant to of m 
the county of in the year , and was actually engaged in dis¬ 
pensing and compounding prescriptions, and that I had attained the full age of 
twenty 0 -one years at the time of the passing of the Pharmacy Act, 1868. 
J N. 0., Assistant. 
2 p 
VOL. IX. 
