Banking Details Change Due To Pharmacy Ownership Change

Download Pharmacy Registration form (to be completed by new owner)
Download the C2 Memorandum of agreement (to be completed by new owner)
Download the Authorisation Form (to be completed by previous and new owner)
Complete the required fields
Upload Pharmacy Registration form
Upload the C2 Memorandum of Agreement
Upload the Authorisation Form
Upload the bank letter/statement reflecting the pharmacy banking details (not older than 3 months)
Upload a copy of ID of new owner
Upload a copy of ID of previous owner

For all queries related to new pharmacies and change of details please contact +27 (0) 860-932-273 or e-mail [email protected].

"*" indicates required fields

BHF nr*

Pharmacy Name*

Name & Surname*

Phone Number*

Email Address*

Pharmacy Registration form*

Upload completed pharmacy registration form

Max. file size: 128 MB.

C2 Memorandum of Agreement*

Upload your completed C2 Memorandum of Agreement form

Max. file size: 128 MB.

Authorisation Form*

Upload your completed authorisation form

Max. file size: 128 MB.

Bank letter/statement reflecting the pharmacy banking details (not older than 3 months)*

Max. file size: 128 MB.

Copy of Previous Owner's ID Document*

Max. file size: 128 MB.

Copy of New Owner's ID Document*

Max. file size: 128 MB.

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