THE INDIAN MEDICAL PRACTITIONERS CO-OPERATIVE PHARMACY & STORES ( Multi State Co-operative Society) LIMITED, X-185, 34-37,

Kalki Krishnamurthy Salai, Thiruvanmiyur, Chennai 600 041. E-MAIL ID : impcops@dataone.in WEBSITE : www.impcops.org Phone : 044 24520189,24520244,24521029 FAX : 044 - 24523313 APPLICATION FOR HONORARY MEDICAL CONSULTANT

Please affix applicants recently taken passport size photo

1. Name of the Applicant ( In capital letters)

2. Date of Birth & Age : (*) Please enclose a proof for date of Birth 3. Gender 4. Father/Husbands name : Male / Female :

5. (a) Qualification : (*)(Please enclose attested copy of Degree /Medical Registration Certificates) (b) No. of years in practice 6. Place of Medical consultation centre (Impcops Sales Depot) for which Application is submitted. 7. Communication Address : :

8. Permanent Address (*)(Please enclose proof for Address) 9. i) Phone No. ii) Contact person Cell No. iii) Mail ID 10. PAN Card No. (enclose copy) 11. Any relative working in IMPCOPS 12. If yes Name & Relationship:

: : : : : : Yes / No :

13. Whether the applicant is employed : as full time/part time in Central/State/ Government or in Local bodies/institutions or in any Indian medicines manufacturing companies 14. Other details Experience/professional skills etc.,

DECLARATION I have gone through the terms and conditions and do agree with the same. I am ready to offer Medical consultation at the Impcops Sales Depot as Honorary Medical Consultant. I fully aware that this nomination is purely temporary and the period of nomination is one year commencing from date of nomination. Further I declare that the details furnished above are true and correct to the best of my knowledge.

Signature Note: (*) marked Documents shall be enclosed compulsorily.

IMPCOPS LTD., CHENNAI 600 041

E/2012-2013

29.10.2012

INFORMATION WITH REGARD TO APPOINTMENT OF HONORARY MEDICAL CONSULTANT

The Management of Impcops has decided to nominate Honorary Medical consultants to extend the business activities of IMPCOPS by proposing the following terms and conditions:

1. Must be a Graduate in ISM 2. Must have registered either in the State or Central Register of CCIM and should be below the age of 40. 3. Should normally be a local resident. 4. Should strictly follow the medical ethics- wellbeing of the Patient should be of primary concern 5. Should not be in employment- full time or part time in any Govt. - National, State or in Local Govt- Municipality or in any Indian Medicines Manufacturing company. 6. Should be willing to follow a Standard Treatment Protocol and Professional fees determined by a team of experts constituted by IMPCOPS management 7. Should not bring any disrepute to the Organization or Medical profession. 8. The timings will be a fixed time based on local conditions. 9. Based on the popularity of the Siddha, Ayurveda and Unani system in the given area consultants will be appointed.
10. Nomination of Medical consultant is for a period of one year, renewable at the discretion of IMPCOPS based on performance of consultant. 11. Honorary Medical Consultants can purchase medicines for their requirement from Head Office.

12. If more than one person is willing to be appointed, Seniority,experience, aptitude and professional skills will be determined. The Team consisting of President, Vice-president and Secretary I/C will take the final decision.
13. The employee who is presently working in Impcops or his/her wife/husband or his/her/blood relatives or the blood relatives of either husband or wife who is an employee of Impcops is not eligible to be appointed as Honorary Medical Consultant.

14. Compensation to the honorary Medical consultants will be as follows. Of the total consultation fee of Rs 100 during every visit, Rs 80 will be paid to consultant as honorarium. From the Sales Discount, on the sale of medicines to the patients prescribed by the Honorary Medical consultant, 5% on Gold medicines and 15% for non Gold preparations will be given to the Physician as incentive. 15. Both consultation fees and sale discount as stated in clause 14, will be paid by way of cheque to the Honorary Medical consultants, by the Head office once in 15 days on submission of report about details of consultation offered and also the details of medicines purchased by the patients to whom medicines were prescribed by Honorary Medical Consultant concerned.TDS from this amount will be deducted as per the rules. 16. The period of nomination of Honarary Medical Consultant shall be one year and renewable based on the performance of the Medical consultants concerned. However, such renewal is not automatic and shall be done at discretion of the IMPCOPS. 17. The IMPCOPS shall have every right to accept or reject the applications. The IMPCOPS has also got every right to cancel the nomination of Honorary Medical consultant at any time without assigning reason there for. 18. In case of any dispute of any nature committed by the Honorary Medical
Consultants such dispute shall be referred to the Court or other legal forums within the city of Chennai for adjudication.

SECRETARY INCHARGE Note :- Application form can be downloaded from our website www.impcops.org and filled application may be submitted along with relevant documents and Demand Draft for Rs. 250/- drawn in favour of THE SECRETARY,IMPCOPS LTD. payable at CHENNAI. The applications received without relevant documents and the prescribed fee will be summarily rejected. Applications can also be had at our Head office by remitting Rs.250/- by way of cash or demand draft drawn in favor The Secretary, Impcops Ltd., payable at Chennai.

SALES DEPOTS ADDRESS AND PHONE NUMBERS

1. IMPCOPS SALES DEPOT, HEAD OFFICE SALES SECTION, 34-37, KALKI KRISHNAMURTHY SALAI, THIRUVANMIYUR, CHENNAI 600 041. Ph:044 24521029, 24520189 11. IMPCOPS SALES DEPOT, REGIONAL OFFICE, 27/16/91, BESANT ROAD, GOVERNORPET, VIJAYAWADA 520 002. Ph: 0866-2576285 12. IMPCOPS SALES DEPOT, NO.19, VYSYA HOSTEL BUILDINGS, VEERA SAVARKAR ROAD, HYDERABAD 500 027. Ph: 040-27568375 13. IMPCOPS SALES DEPOT, 14-25-29, DANDU BAZAAR, MAHA RANIPET, VISAKAPPATNAM,A.P. Ph: 0891-2714003

2.

IMPCOPS SALES DEPOT, DOOR NO.627/1A, NEW NO.756, P.H.ROAD, NSK NAGAR, CHENNAI 600 106.

3. IMPCOPS SALES DEPOT, 48, SOUTH MASI STREET, MADURAI 625 001. Ph: 0452-2344475

4. IMPCOPS SALES DEPOT, NO.18, SAMUNDI SHOPPING COMPLEX, FOUR ROAD, SALEM 636 007 Ph: 0427-2418485

14. IMPCOPS SALES DEPOT, D.NO.6-2-84, (1st FLOOR) T.NAGAR, K.T. ROAD, THIRUPATHY TOWN,PIN 517 501, CHITTOOR DT., A.P. Ph: 0877 - 2287707

5.

IMPCOPS SALES DEPOT, NO.50B, 1ST FLOOR, CHINTHAMANI BAZAAR, TRICHY 620 002. Ph: 0431-2708540

15. IMPCOPS SALES DEPOT, SHOP NO,367, DOOR NO.23/369, Ist Floor, ALANKAR PEARL PLAZA, KEMPEGOWDA ROAD, BANGALORE 560 009. 080 - 22354090 16. IMPCOPS SALES DEPOT, SHOPING COMPLEX, SHOP NO.36/1154/14 & 15, THIRUVANANTHAPURAM YATHEEMPHANA,VALLAKKADAVU, THIRUVANANTHAPURAM-695 008. Ph: 0471-2502296 17. IMPCOPS SALES DEPOT, 35, C1-D1, OLD SOUTH RAILWAY LINE, NEAR VANNIYAR KALYANA MANDAPAM, DHARMAPURI 636 701.

6.

IMPCOPS SALES DEPOT, CAUVERY SUPER MARKET BUILDINGS, 2964/1, SOUTH RAMPART, TANJORE 613 001. Ph: 04362-231048

7. IMPCOPS SALES DEPOT, NO.39-D FIRST FLOOR, 100 FEET ROAD, GANDHI PURAM, COIMBATORE 641 012. Ph: 0422-2494081

8. IMPCOPS SALES DEPOT, 256, E/B, THIRUCHENDUR ROAD, MURUGANKURUCHI, PALAYAMKOTTAI, TIRUNELVELI 627 002. Ph: 0462-2580360

18. IMPCOPS SALES DEPOT, G.S.R. COMPLEX, NO.52, RAMAR PILLAI STREET, NEAR DISTRICT EMPLOYMENT OFFICE, RAMAVARMAPURAM, NAGERCOIL 629 001.

9. IMPCOPS SALES DEPOT, SHOP NO.8,CITY PLAZA B-ANNEX, VARADHARAJ SHOPPING COMPLEX, NO.11,(OLD NO.7), MAIN ROAD, DINDIGUL 624 001. PH; 0451 - 2434311 10. IMPCOPS SALES DEPOT, NO.147, 1ST FLOOR, KAMARAJ SALIA, PILLAITHOTTAM, PUDUCHERRY 605 013 Ph: 0413/2244667

19. IMPCOPS SALES DEPOT, 176, PALAI ROAD, OPP. RAJAJI PARK, THOOTHUKUDI 628 008.

20. IMPCOPS SALES DEPOT, 21/9, NORTH MURUGANATHAPURAM, KARUR 639 001.