Enquiry Number : 0135-2608897

 

APPLICATION FORM FOR REGISTRATION OF ADDITIONAL QUALIFICATION(S)

Form 8
[Rule 3(6)]
Uttarakhand Medical Council, Dehradun
Serial No. : 1021
Date :
Banker's cheque/ bank draft no. :
Date :
APPLICATION FORM FOR REGISTRATION OF ADDITIONAL QUALIFICATION(S)
1. Name of the Applicant :
Surname : Middle Name : First Name :
Maiden Name (in case of married women) :
2. Father's Name :
3. Gender: Male Female
4. Email:
5. Address : Temporary
Permanent
6. Date and Place of Birth :
7. Name of the Additional Degree/Diploma obtained and University/Licensing body with the yearof obtaining the
same.The subject of post graduation(s) should also be indicated.
8. Registration No. in Uttarakhand Medical Council with date.
9. Date :
10. Applicant's Signature:
11. Enter The Code As Shown In Image :  

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