Get Application For Renewal Of Pharmacist Gold Certificate On Voluntary Inactive Status For Year 2015

This guide provides a clear and supportive approach to filling out the application for renewal of the pharmacist gold certificate on voluntary inactive status for the year 2015. By following the outlined steps, you can ensure that your application is completed accurately and submitted without issues.

Follow the steps to successfully complete your renewal application online.

1. Click the ‘Get Form’ button to obtain the application form and open it in your browser.
2. In section 1 titled 'Contact Information', provide your full name and license number. Then, enter your mailing address, including your city, state, and ZIP code. Next, fill in your telephone numbers and email address to ensure effective communication.
3. Proceed to section 2, the 'Survey', where you will provide information regarding your current practice status. Select the applicable option that describes your situation among the given choices related to your pharmacy practice.
4. Continue to section 2, where you will specify your employment status if you are not currently practicing pharmacy. Choose the description that best matches your current employment from the listed options.
5. Move on to section 3, 'Attestations'. For each question, confirm your understanding by selecting 'Yes' or 'No'. It is crucial to read and comprehend these statements thoroughly to avoid misunderstanding your license status.
6. Once all questions are answered, provide your signature and the date on the final page of the application. Ensure that this is your original signature, as stamped or facsimile signatures are not accepted.
7. Review the application to confirm you have filled out all sections completely and accurately. Check that you have both pages of the form and ensure all questions have been answered.
8. After verifying all details, save your work and prepare to print. Once printed, mail the completed application to the address provided at the top of the form.

Prepare your application now and submit it online to ensure timely processing.