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Application Form

1. The document provides instructions for registration as a paramedical practitioner with the Himachal Pradesh Paramedical Council. 2. It lists the required documents for registration including matriculation certificate, 10+2 certificate, degree/diploma certificate, internship certificate, photographs, and registration fee. 3. The renewal process requires a renewal application form, alive certificate if not appearing in person, renewal fee, and original registration certificate.

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आयुष चौधरी
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2K views

Application Form

1. The document provides instructions for registration as a paramedical practitioner with the Himachal Pradesh Paramedical Council. 2. It lists the required documents for registration including matriculation certificate, 10+2 certificate, degree/diploma certificate, internship certificate, photographs, and registration fee. 3. The renewal process requires a renewal application form, alive certificate if not appearing in person, renewal fee, and original registration certificate.

Uploaded by

आयुष चौधरी
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Phone No.

0177-2808910

>NOTE
Letters.
1. All form to be filled in
Block Letters/ Capital
candidates.
have to be submitted by
the concerned
2. The Registration form shall
time of registration.
Documents to be brought at the
3. Original
essential at the time of registration.
4. Presence of the candidate is
form as per list.
5. All the be attached with registration
Documents should

available form the office of


the Council @Rs. 100/-
Renewal form
6. Registration/
each.
Essential Documents
required for the

Paramedicals with the Council.


registration of
(Attested)
1. Matriculation
2. 10+2 (As per R&P rules of HP) (Attested)
3. Himachali Bonafied (Attested)
institutions by UGC/ Health
with Mark sheets (Recognized university/
4. Degree / Diploma
qualification
Governments where the institution exist and paramedical
Department State
of HP. (Attested)
as per R&P rules
by the concerned Principal/ In-
5. Batch Certificate (Duration of session/ Regular Mode)
(Attested)
charge of the University/Institution.
where the candidate has imparted
certificate issued by the hospital
6. Hospital attachment
minimum 50 bedded Multispecialty Hospital.(Attested)
6 months practical training
the Council)
7. Affidavit ( as per
the specimen prescribe by
attested by the Principal
of the concerned University/ Institution
8. One Photograph
on the registration form)
(affix/paste
officer (attached with paper pin on the
attested by from any Gazetted
9. Two photographs
form). of India, Dental College, IGMC.
deposited in the State Bank
10. Registration Fee
office of the Council after verification of
Voucher available in the
Shimla through Cash
the Documents.

Fee Rs. 1500/


11. Registration

12. Certificate of
internship (if required).
Renewal
1. Renewal application form available in the office of the Council @ Rs. 100/- each.
2. One photograph ( affix / paste on the application)
3. Alive certificate is required if the candidate do not appear at the time of renewal.
4. Renewal Fee Rs. 750/-
5. Late fee Rs. 500/- per year.
6. Original Registration Certificate.
AFFIDAVIT

S/o, D/o years R/o Vill. P.O.


I, aged
Tehsil Distt. do hereby solemnly affirm and
declare on oath as under:

1. That I have done year Degree/ Diploma in in the


session of under Roll No. Sr. No. from the
university/ institute of The university/institute is
recognized by
2. That I do hereby
verify that the said Diploma/ Degree has been
imparted through Regular mode/ Distance Mode
3. That I do hereby
verify that the contents of this affidavit 1 & 2
are true to the best of
my knowledge and belief.
In case any contents of this affidavit found
wrong by the Council shall
have an
authority of the cancellation of my
Diplomain with the Council.
registration as
Degree/

Deponent
Verification:
I, the above named
deponent, do hereby verity that the
above affidavit are true contents of myv
and correct to the
belief. No part of it is false best of my
and nothing
material has been
knowledge and
from. concealed there
Verfied at on thiss
day of

Deponent
FORM OF APPLICATION FOR ENROLMENT IN THE STATE REGISTER OF
PARAMEDICAL PRACTITIONERS

To
The Registrar,
Himachal Pradesh Paramedical Council,
Shimla H.P
Sir,
am to
request you kindly register my name Paramedical Practitioner in the State
as a
Register of Paramedical Practitioners maintainedunder sub-section (2) of section 38 of the Himachal
Pradesh Paramedical Council Act, 2003 and to issue me
necessary Certificate of Registration to
practise within the State of Himachal Pradesh Necessary
as under
particulars concerning case are my given
1. Name of the applicant (in block
letters)..
''*'******************* * ***** ***********'****''''

2 Father's name (in block letters)..


****'****'***''****'** *********** *********** ************'***** '****'.
3 Address.

Date of Birth and age on the Date of presenting Application. ' '''*'''''''*''''*''''*°''*******'******************
5. Place of Practice
(a) Town of Village:
(b) Post Office.
(c) Tehsil. * ** ** ************** *****'''***'**'**'*'*
**'**************
(c) District. **************'*****'''******'**'''*''** ********* ***** *
. Qualification and Date of obtaining them...
7. The name of the college or institution from where he passed the examination ...
************'**************'**°
*********"**''"**********'******************° *****"'***********'**'°''''''*'*************
8. Date on which applicant started practice..*********''''****'"'°°''''**'***'***'"'**''''''' '''°'**'''*".
9 Telephone No. *******'''***''

10. System in which practicing/will practice..


11. Rupees. ...as registration fee in the form of a
demand draft drawn on
ScheduledBank in favour of the Himachal Pradesh a.. ***'***

Paramedical Council, Shimla-171001


Demand Draft No.. ...
Dated. . )is enclosed:
12 The following documents duly attested by Gazetted Officer are enclosed:
(a) Matriculation Certificate:
(b) Copies of degree, diplomas, Certificate and testimonials.
(c) 3 Copies of Passport Size
Photograph.
I solemnly declare and affirm that the
contents given, in the
12 above are correct to application for
registration, in paras 1 to
the best of my knowiedge and belief. I further declare on oath that
has been concealed. nothing relevant

Date..
Signature of the Applicant
Place....

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