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Renewalofregistration DMC

The document is an application form for renewal of registration with the Delhi Medical Council. It requests information such as the applicant's name, address, contact details, details of additional qualifications, Delhi Medical Council registration certificate number and date, present occupation and address. The applicant must submit recent passport photos, the original registration certificate, and a bank draft for Rs. 1000 as the application fee. The applicant also must sign a declaration agreeing to abide by the ethics codes of the Delhi Medical Council and Medical Council of India.

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1K views2 pages

Renewalofregistration DMC

The document is an application form for renewal of registration with the Delhi Medical Council. It requests information such as the applicant's name, address, contact details, details of additional qualifications, Delhi Medical Council registration certificate number and date, present occupation and address. The applicant must submit recent passport photos, the original registration certificate, and a bank draft for Rs. 1000 as the application fee. The applicant also must sign a declaration agreeing to abide by the ethics codes of the Delhi Medical Council and Medical Council of India.

Uploaded by

amitbeniwal4014
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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DELHI MEDICAL COUNCIL

Room 308A, 3rd Floor, Administrative Block Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi 110002 Phone : 23237962 (4 Lines) Fax : 23234416 Email : [email protected] Wesbiste : delhimedicalcoundil.nic.in

Receipt No. : Date :

Bank Draft No. ______________________ Date _______


APPLICATION FORM FOR RENEWAL OF REGISTRATION 1. Name of the applicant (In block letters) First Name Middle Name Fathers Name Gender : Male / Female Address (Mailing Address) Permanent Address 5. (a) Telephone Number (c) Email Address (b) Mobile No.

Surname

2. 3. 4.

6. Details of Additional Qualification for incorporation, if any : S.No. Description of Name of the Name of the the qualification College/Medical Institution University/Licensing Body

Year of passing the examination

7.

Delhi Medical Council Registration Certificate No. ____________ dated _______ surrendered and attached herewith.

8.

Present Occupation with address :

I submit herewith the following :a) Three recent passport size photographs with name and signature at the backside b) c) Original Delhi Medical Council Registration Certificate Bank Draft No. ______________ dated ________ drawn on _____________________ Bank for

Rs. 1000/- (Rupees One Thousand Only) as non-refundable fee in favour of Delhi Medical Council payable at New Delhi

Date __________

Signature of the Application

DECLARATION
I solemnly affirm & declare that the above entries made by me are correct, and undertake to abide by the Code of Ethics of Delhi Medical Council and Medical Council of India and by the Rules of Delhi Medical Council.

Date __________

Signature of the Application

Inclusion of additional qualification (if application) Please submit your application personally or through an authorized representative at the office of Delhi Medical Council, so that your additional qualification certificate can be verified with the original document. The original degree/diploma certificate will be returned immediately after verification and a photocopy of the same will be retained.

_______________________________________________________________________________ For Office Use Only

Acknowledgment of the receipt of Registration Certificate Received the above document in original Signature of registered person. Name.. Date.

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