Central Drugs Standard Control Organisation
Directorate General Of Health Services
Ministry of Health & Family Welfare, Government of India
SUGAM - An e-Governance solution for CDSCO

Form 12A

[See Rule 36, second proviso]

Application for the issue of a permit to import small quantities of drugs for personal use.

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Patient Detail
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+91
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Residential Address
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(Please include STD Code - Phone Number)
+91
Multiple Contact Numbers can be added with comma separation
Occupation Details
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(Please include STD Code - Phone Number)
+91
Multiple Contact Numbers can be added with comma separation
Note:
  1. The quantity of any single drug so imported shall not exceed one hundred average doses.
  2. While collecting the consignment, please furnish the original application form and prescription of doctor to the port office for verification.
Product Details
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10 per strip or 10 ml per bottle
Edit Product Details
Name of Drug Quantity Edit Delete
    Multiple selection is possible. However, actual import could be done from only one country.
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    Note:
    1. It is mandatatory to submit system generated Form 12A.
    2. Click 'Download Form12A' Button available at the bottom of this page to download system generated Form.
    3. Sign the Downloaded Form and upload it back into the system after scanning in the 'Submit Form' step.

    Form 12A

    [See Rule 36, second proviso]

    Application for the issue of a permit to import small quantities of drugs for personal use.

    I resident of by occupation hereby apply for a permit to import the drugs specified below for personal use from

    I attach a prescription from a registered medical practitioner in regard to the need for the said drugs.

    S.No. Names of Drugs Quantity which may be imported
      26-Apr-2024  
      Note:
      1. Upload the Signed Form12A, downloaded from the "Preview" Step.
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