THE AMENDED PHARMACY BILL. 
83 
SCHEDULE D. 
Declaration to be signed by a duly qualified Medical Practitioner , or Magistrate , 
respecting a person who was 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 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 for three years 
immediately 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. 
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 Assistant to of in 
the county of in the year , and was for three years immedi¬ 
ately before the passing of this Act actually engaged in dispensing and com¬ 
pounding prescriptions, and that I had attained the full age of twenty-one years 
at the time of the passing of the Pharmacy Act,*1868. 
N. 0., Assistant. 
SCHEDULE F. 
Date. 
1 
Name of 
Purchaser. 
Name and 
Quantity of 
Poison sold. 
Purpose for 
which it is 
required. 
Signature of 
Purchaser. 
Signature of 
Person 
introducing 
Purchaser. 
• 
j 
1 
! 
G 
O 
