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Pmdc Renewal Form

Pmdc Renewal Form

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Published by hap hazard
renewal form for PMDC registration
renewal form for PMDC registration

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Categories:Types, Resumes & CVs
Published by: hap hazard on Aug 13, 2013
Copyright:Attribution Non-commercial

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10/22/2014

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PM&DC–FORM-II
RETENTION OF NAME ON THE REGISTER OF
MEDICAL/DENTAL PRACTITIONERS
 
TEL: UAN 111-321-786 , 9266004 Fax No.051-9266427Website: www.pmdc.org.pk E-mail: pmdc@pmdc.org.p
 
These forms can be downloaded from our website by using Acrobat Reader. Photocopy of this form is also acceptable
PMDC Registration No
 — 
The Registrar Pakistan Medical & Dental CouncilG-10-/4, Mauve Area, Islamabad.Sir,
It is requested that my name may please be retained on the register of the council for a further period of 
five
 years. I am enclosing the following documents: -1. Original PM&DC Registration Certificate.2. Copy of MBBS/BDS degree/postgraduate degree/diploma attested by the respective Principal or his authorizedProfessor. (mandatory requirement if not submitted earlier)3. Three recent photographs (2 Passport size and one identity Card size)4. Copy of National I.D Card.
Fee deposited (in Rupees)
Fee for retention of name inmedical register Late fee Urgent fee Courier charges Change in certificate Total fee
A bank draft/pay order of Rs._______________ No._____________________________Dated_________________  Name of issuing branch_________________________________________________________________________ 
(Name & Registration No. of Doctor must be written on the back side of bank draft)
Cash can be deposited at the counter in the PM&DC office Islamabad.
(Fill in with block letters)
Name withFather’s NameDate of BirthQualifications alreadyregisteredPermanent AddressPresent Mailing Address
City/DistPhoneCity/DistPhone
Present place of practice/posting (complete address with designation) ___________________________________ 
 Note
: For registration/recognition of additional postgraduate qualification use PM&DC form No.6 & 7.In case of any deficiency in documents/fee the case will not be processed further 
.
 
Undertaking:
I undertake to abide by the Code of medical Ethics prescribed by the PM&DC for registered Medical/dental practitioner and willinform the Register, Pakistan Medical and Dental Council of any change of address of residence or practice with in thirty days. If considered necessary, PM&DC may disclose any information when asked for. I further undertake that if there has been an erroneousentry in the certificate, I shall send it back for correction if asked by the PM&DC and that the above information is correct and nothinghas been concealed and if found false or contrary to PM&DC rules I am liable for necessary action by the Council leading tocancellation of registration.
 Name _________________________________ Signature ___________________________ Dated____________Tel:_________________________ Email:_____________________________________ Date_________________ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
(
For office use only)
Received Rs._________(Rupees____________________________) vide receipt No.___________dated__________ 1. Registration renewed on ____________________________ & valid upto _________________ /I/D Cardissued/Not issuedAssistant Superintendent Assistant/Deputy Registrar Registrar 
 
 
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