Community Pharmacy Licence Transfer of Ownership
About this form
This form is to be used to apply for a transfer of ownership of a Community Pharmacy Licence under the Public Health Act 1997 (the Act).
This application form must be completed by the current licensee(s) and the new applicant(s).
A licence is issued to the owner(s) of the pharmacy, who is/are the person(s) who will have overall responsibility for the business, including responsibility for any contraventions of the Act. Accordingly:
- Trusts will not be licensed. Companies operating as trustees for a trust will be licensed in the company name only.
- Applications listing a partnership as the owner will not be accepted. If your business is operated by a partnership, one or more of the individuals in the partnership will need to be listed.
This form requires you to submit the following attachments (PDF is the preferred format for these attachments):
- One form of current photographic identification sighted and certified by an authorised witness must be provided for each signatory/owner. Acceptable forms of photographic identification include Driver's licence, Proof of age or identity card issued by a State/Territory, Passport. A list of authorised withnesses for true and correct copies can be found on the Attorney-General's Department website.
- For company applications a copy of the company's current extract (issued within the previous 30 days) from the Australian Securities and Investment Commission (ASIC). This can be obtained on the ASIC website.
A fee of $374 is associated with this application.
Payments up to $10,000 can be made with either Visa or MasterCard.
Your personal information
Access Canberra uses this form to collect information which is necessary to allow the ACT Government to provide services to you. Personal Information may be used or disclosed in accordance with the Information Privacy Act 2014.