APPLICATION FOR THE RENEWAL OF REGISTRATION THE REGISTRAR

ТО

Maharashtra Medical Council Anand Complex,
2 Floor, Sane Guruji Marg,
Arthur Road Naka, Mumbai - 400 011.

Photo To be Affixed

Sub.: Dr. (Smt./ Shri)

Registration No:

Rogn. Date:

Sir,
I the undersigned applicant, request you that my name may be continued on the Register of Medical Practitioners maintained by the Maharashtra Medical Council as per 23 (a) / 23 (c) of MMC Act 1965 and amendment 2003. My particulars are as under :-

Name of the Applicant (Beginning with sumame in capital Letters )

Surname

First Name

Middle Name

Father/Husband's Name

Surname

First Name

Middle Name

Mother's Name

Surname

First Name

Middle Name

Date of Birth of the Applicant:

Residential Address:

Taluka / City

District

Postal Index No.(PIN)

Tel. No.: (Resi.)Clinic

Tel. No.: (Resi.)Mobile

Details of Qualification

Name of College ( M.B.B.S./ Other )

University ( M.B.B.S./ Other )

Year of Passing

MBBS Regl. No.

MBBS Regl. Date

Name of College ( P.G. Qualification )

University ( P.G. Qualification )

Year of Passing

Add. Reg. Cert. No.

Add. Reg. Cert. Date

I enclosed herewith attested photocopies of following documents :
1. Photocopy of the Certificate of Registration of Maharashtra Medical Council.
2. Demand Draft / Pay Order favouring Registrar, Maharashtra Medical Council Payable at Mumbai.
3. Xerox copy of MMC I-Card.
4. Three copy of Latest passport size Photograph.
5. C.M.E. Credit Hours (Please 500 notice on website - http://maharashtramedicalcouncil.org)
6. Attested Xerox copies of CME Certificates Showing Credit Hours.

Declaration I shall abide by the Code of Medical Ethics as enunciated in the Indian Medical Association (Professional Conduct. Etiquette and Ethics) Regulations, 2002.

By creating an account you agree to our Terms & Privacy.