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Clinical Establishment Registration North Goa District PC-PNDT Section, Collectorate Building, North Coa District, Panaji-Goa. ‘+ Procedure to apply: ¢ Download Form | from www.northgoa.gov.in ¢ Covering Letter to Collector regarding submission of Form | * Form | ( Application Clinical Establishment) ** Documents Required:- 1. Valid Medical Council Registration (Self Attested) 2. Degree Certificate (Self Attested) 3. Proof of Establishment:- Public Health Department License/House Tax/Trade Licences/Electricity bill 4. Authorization Certificate from Goa State Pollution Control Board under Bio Medical Waste, Rules 1994 5. DD in name of: - District Registration Authority North Goa. { [tran Tor Permanent Registration Deseription Out Patient | Care Care | _Rs.1500 | Rs. 1000 Rs, 2500 Diagnostic Other fees: ©) For Renewal, fee will be same as registration fee (Provisional/Permanent). \\) For Late Application, enhanced fee equivalent to double of the registration fee forProvisional/Permanent registration shall be charged. (ii) For Duplicate Certificate, the fee of Rs 1000/- shall be charged. (®) Change of Ownership, Management or Name of Establishment, the fee of Rs 2000/-shalll be charged. (v) For any appeal the fee shall be Rs. 1000/-. Account Name: District Registration Authority North Goa. Bank Name & Branch: Bank of India, Patto, Panaji-Goa A/c No.: 102910110007033 ISFC Code: BKID0001029 MICR Code: 403013031

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