Community Pharmacy Licence Variation Application
About this form
This form is to be used to apply for a Variation to a Community Pharmacy Licence under the Public Health Act 1997 (the Act). You can access the Act and its regulation at the Legislation Register.
You cannot change the premises location using this form. A new application must be submitted.
You cannot use this form to transfer the ownership of a Community Pharmacy Licence. A Transfer of Ownership application must be submitted.
The original licence certificate must accompany this application.
If the Variation is a Refurbishment, a floor plan showing the layout of all fixtures and fittings of the premises must be attached.
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.