Self-declaration for the use of medicines containing Schedule E1 drug

I am over 21 years of age and hereby declaring that I am purchasing this medicine for my own medical use or I am a caretaker of a person who needs it for medical use. I affirm that this medicine is being purchased by me based on the prescription given by my doctor and I will also ensure that this medicine is used only under the supervision of a certified medical practitioner.

I want to use this medicine for the treatment of symptoms related to my existing medical condition/ conditions. I am well aware of the medical benefits and the side-effects related to Cannabis medicines.

I, my heirs, assigns or anyone acting on my behalf, hold the manufacturer/ supplier free of any harm or any liability resulting from the use of this medicine. I understand that this medicine may affect my co-ordination and cognition in ways that could impair my ability to drive, operate machinery, or engage in potentially hazardous activities. I assume full responsibility for any harm resulting to me or other individuals as a result of my use of this medicine.

I also declare that I will not get involved in any recreational/ resale activities.