An application referred to in sub-regulation (1) shall be accompanied by a prescribed application fee and contain at least the following information:
(a) The name and both residential and business addresses (both physical and postal) of the applicant;
(b) the exact location of the premises where dispensing, or compounding and dispensing will be carried out;
(c) telephone number;
(d) email address, if applicable;
(e) fax number, if applicable; and
(f) proof of registration with the relevant statutory health council.