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JK"V H VK Qfozkku VK KSX: VKPKJ VKSJ FPFDRLK Iathdj.K CKSMZ

This document contains an application form for doctors to obtain a Certificate of Good Standing from the National Medical Commission of India. The application requests information such as the doctor's name, qualifications, registration details, work history for the last 5 years, and payment details. It provides instructions on completing and submitting the form, including enclosing the registration certificate and payment of fees. A checklist is also included to ensure all required documents are submitted.

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Joseph Nadakkavukaran
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48 views

JK"V H VK Qfozkku VK KSX: VKPKJ VKSJ FPFDRLK Iathdj.K CKSMZ

This document contains an application form for doctors to obtain a Certificate of Good Standing from the National Medical Commission of India. The application requests information such as the doctor's name, qualifications, registration details, work history for the last 5 years, and payment details. It provides instructions on completing and submitting the form, including enclosing the registration certificate and payment of fees. A checklist is also included to ensure all required documents are submitted.

Uploaded by

Joseph Nadakkavukaran
Copyright
© © All Rights Reserved
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
You are on page 1/ 5

Good 

Standing Form 

jk”Vªh; vk;qfoZKku vk;ksx


NATIONAL MEDICAL COMMISSION
vkpkj vkSj fpfdRlk iathdj.k cksMZ
Ethics and Medical Registration Board
Pocket- 14, Sector- 8, Dwarka, Phase – 1, New Delhi-11007
पॉकेट -14, सेक्टर-8, वारका, फेस-1,नई िद ली-110077 

APPLICATION FORM FOR OBTAINING A


CERTIFICATE OF GOOD STANDING
(Please read the instructions carefully as given in Appendix-I before filling the form.)

1. NAME OF THE DOCTOR (AS GIVEN


IN THE INDIAN MEDICAL REGISTER)

2. FATHER’S / MOTHER’S/ HUSBAND’S


NAME (AS GIVEN IN THE STATE
MEDICAL REGISTER)

3. PRESENT ADDRESS WITH CONTACT DETAILS

(including e-mail and mobile number)

4. ADDRESS WITH CONTACT DETAILS IF


CERTIFICATE IS TO BE SENT ABROAD.
( including e-mail of the concerned authority
and applicant reference number if any)

5. QUALIFICATION
(NAME OF THE UNIVERSITY WITH YEAR)

6. NAME OF THE COLLEGE WHICH APPLICANT


STUDIED AND QUALIFIED FROM:

7. STATE MEDICAL COUNCIL (S) WITH WHICH


REGISTERED REGISTRATION NO. (S) AND DATE (S).

8. PLACES AT WHICH HE HAD WORKED DURING


THE LAST FIVE YEARS WITH FULL DETAILS
(PLEASE USE SEPARATE SHEET IF SPACE
IS NOT SUFFICIENT).

1
Good Standing Form 

9. DETAILS OF PAYMENT OF FEES :

(a) PAID BY DEMAND DRAFT :

(b) AMOUNT RUPEES :

10. DETAILS OF DEMAND DRAFT:-

(a) NAME & ADDRESS OF ISSUING BANK :

(b) DEMAND DRAFT NO. & DATE

SIGNATURE OF THE CANDIDATE


DATED
PLACE

RECOMMENDATION OF THE STATE MEDICAL COUNCIL: -

1. CERTIFIED THAT THE PARTICULARS GIVEN ABOVE ARE CORRECT TO THE BEST OF MY
KNOWLEDGE AND ACCORDING TO THE RECORD AVAILABLE WITH ME.

2. CERTIFIED THAT DOCTOR S/O HOLDS CURRENT


REGISTRATION WITH THIS COUNCIL AND NO DISCIPLINARY PROCEEDINGS HAD BEEN
TAKEN OR WERE IN PROGRESS AGAINST HIM ON THIS DATE BY THIS COUNCIL.

REGISTRAR,
STATE MEDICAL COUNCIL
DATED:

NOTE: THE CERTIFICATE OF GOOD STANDING ISSUED BY THE NATIONAL MEDICAL COMMISSION WILL BE 
VALID UPTO SIX MONTHS FROM THE DATE OF ISSUE. 

2
Good Standing Form 

APPENDIX-I

INSTRUCTIONS TO CANDIDATE FOR FILLING THE APPLICATION FROM FOR OBTAINING A CERTIFICATE OF GOOD 
STANDING. 

1. THE APPLICATION FORM SHOULD BE PROPERLY AND NEATLY FILLED IN.

2. THE APPLICATION IS TO BE FORWARDED TO THIS OFFICE THROUGH THE


REGISTRAR OF THE STATE MEDICAL COUNCIL WITH WHOM THE PERSON
CONCERNED IS REGISTERED. IN CASE HE IS REGISTERED WITH MORE THAN ONE
STATE MEDICAL COUNCIL THEN HE SHOULD GIVE ALL THE REGISTRATION
NUMBERS, WITH DATES AND THE NAME OF THE STATE MEDICAL COUNCILS, BUT
FORWARD HIS APPLICATION THROUGH THE REGISTRAR OF ONE OF THE MEDICAL
COUNCILS. IN CASE OF DOCTORS REGISTERED WITH ERSTWHILE MEDICAL
COUNCIL OF INDIA, AN OPTION TO APPLY ONLINE IS AVAILABLE. AFTER
CREATING ACCOUNT IN DOCTOR’S LOGIN ON NMC WEBSITE, YOU CAN APPLY FOR
GOOD STANDING CERTIFICATE.

3. PLEASE ENCLOSE AN ATTESTED COPY OF THE PERMANENT REGISTRATION


CERTIFICATE.

4. NON REFUNDABLE APPLICATION FEE OF RS. 2000/- (RUPEES TWO THOUSAND


ONLY) + 18% GST BY A BANK DRAFT IN FAVOUR OF “THE SECRETARY, NATIONAL
MEDICAL COMMISSION, NEW DELHI”, PAYABLE AT NEW DELHI. ON REVERSE OF
THE DRAFT, FOLLOWING DETAILS TO BE FILLED BY THE APPLICANT AND DULY
SIGNED: -

(a) Name
(b) Father’s Name
(c) Purpose for which the draft submitted
(d) Telephone No with E-MAIL/Mobile No.

5. IF THE CERTIFICATE HAS TO BE SENT ABROAD BY COURIER OR BY FAX TO THE


FOREIGN COUNCIL/COUNTRY THEN THE FEE WOULD BE $100+ 18% GST OR RS.
8900/- (EQUIVALENT) IN INDIAN CURRENCY.

6. IT IS FOR THE INFORMATION OF THE CANDIDATES THAT THE DIGITALLY SIGNED


CERTIFICATES WOULD BE SENT BY E-MAIL. ONLY ON SPECIFIC REQUEST HARD
COPY WILL BE SENT THROUGH REGISTERED POST/ SPEED POST.

7. ALL QUERIES MAY BE ADDRESSED TO NATIOAL MEDICAL COMMISSION MAY BE SENT


TO [email protected].

8. APPLICANT IS ADVISED TO RETAIN COPY OF HIS APPLICATION AND DRAFT FOR


FUTURE REFERENCE

*************

3
Good Standing Form 

CHECK LIST for submission of documents


 

The candidates are requested to ensure that the documents be enclosed 
as  per  the  order  in  the  Checklist.  All  papers/documents  should  be 
numbered according to the checklist. Please arrange the application in the 
following order & tick mark the relevant boxes. 

1. Application fee of Rs. 2000/- + 18% GST……. Yes No

2. Extra fee, if the certificate is to be sent abroad Yes No

3. Application form …………………….. Yes No

4. Recommendation of the State Medical Council Yes No

5. Attested copy of Permanent Registration Certificate Yes No

6. E-mail where certificate is to be sent Yes No

Signature ……………….
Date ……………………………………. 

 
jk”Vªh; vk;qfoZKku vk;ksx Good Standing Form 

NATIONAL MEDICAL COMMISSION


vkpkj vkSj fpfdRlk iathdj.k cksMZ
Ethics and Medical Registration Board
Pocket- 14, Sector- 8, Dwarka, Phase – 1, New Delhi-11007
पॉकेट -14, सेक्टर-8, वारका, फेस-1,नई िद ली-110077 
 

ACKNOWLEDGEMENT
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
(to be filled by the candidate)

Received Application from Ms/Mr.……………………………………………………………

D/o / S/o Sh……………………………………………………......... alongwith Bank Draft/DD

No…………………………… dated..………………………….. for Rs……………………….

Drawn on Bank…………………………………………………………………………………

for issuance of Good Standing Certificate for consideration.

Signature of Receiving Official with date

  OFFICIAL
SEAL

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