128 
THE PHARMACY ACT, 1868. 
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. 
Name of 
Purchaser. 
Name and 
Quantity of 
Poison sold. 
Purpose for 
which it is 
required. 
Signature of 
Purchaser. 
Signature of 
Person 
introducing 
Purchaser. 
