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Dr. - Medical (GP)Dr. - VeterinarianDr. - DentalPharmacist

Name of Dr or Pharmacist

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MMC / MVC / MDA / Pharmacy Reg. No:

Name of Clinic or Pharmacy:

Upload IC copy
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Upload Latest APC (Drs Only) / Poison A License (Pharmacist Only)
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Council License (Lesen Majlis)
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Upload SSM
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