PM &DC. FORM.

II
I APPENDIX-5
REOUEST fOR RETENTIOi" Of NAME 0:'1 THE REGISTER OF
MEDICAUDENTAL PRACTITIONERS
TEL: 051-9106151-54,
Website:
~w.pmdc
This

'0fTI'"

UAN: 111.321-786, Fax 1"0.051.9106159

org.pk
.Ii:.miu.l.; pmdc@pmdc.org.pk

can tie dOWflloaded

Please paste
one
Passport Size
Photograph

Reac:e'.

from our
ebsite by uSing Ac"Obal

PI1010c0P~ 01 this form is also accepta:lle

PM DC Registration

The Registrar
Pakistan Medical & Dental Council
G.l0./4. Mauve Area,
Islamabad.

No

Sir,
It IS requested

lhat my name may please be retained on the register of the Cou~cil for a further period of five years.

am endosing ttle following documents:(If rtlt' rollo .

ln2 documenl.
unllctinnrd.

C~~
1.
2.

3.
4.
5.
6.
.7

In' not .lte~ltd

and anaehed with thi~ appliution

II shill! nOl be' procnscd Ind shall be returned

Original PM&DC Registration Certificate for replacement

Only if not submitted earlier, a copy of MB8S/8DS
degree/dully attested, (For attestation see overleaf instruct.ons)
Three recent photographs with white background and both ears visible dUly attested.
Photocopy of C.N.I.C
Required fee (see details overleaf.)
For foreign nationals purpose letter req'Jired from the concerned institution

fee deDosited (in Rupees)

Fee for relention of name

in medlcaUdental register

A bank draft/pay order of

as.

any Change in
certificate

Courier charges

Urgent fee

Late fee

So.

Total fee

Dated -------------

Name of issuing branch ------------------------------------------a'llOlnt RqiJ"vtiol'l

Cilsh can be depos:ted

Fill in with block

at the Bank counter in the P\1&DC

.''1io,01 DoClor " "1 be' "',itlt'" 0" ,Itt' bod

./Jt of

lui". d"J/I}

office Islamabad.

letters
Date of
Birth

Name witn
Father's Name

.7. Anesled copy of Tral'llng lener or Experience

Mention qualifications
already registered with
CoHegelUniversily name

Present Mailing
Address

Pennanent Address

cef1ificale 3S a proof or training Institute in case of already reorslered

FCPSlMCPS

Qua~f\catlon.

Undertaking:
Icndenake to abIde by the Code of EL'lies (Of practice presenbcd b~ the Pakistar, Medieal and Dental (:Ollnell for registered \-1edleaLtOmtal Pllicull0rm and
wil1lnfonn the Ikgl~rrar, PM& OC of any change ofaddn:~ will; in Ihirt) dJys I( con~jde::ed nec~~ary, PM&DC may disclose any mfonnaw.m .
heo ;uked for
Ofowin any IOfol"IT'3lionfrom a:ny of my o::dueatiO:lalUUlIf'..lllol15
ar.d llil>era.le PM&DC iUldthe iWiIlNllon for any liablhry (Of thls action, I funher uooeruke
thai If.1:1e:Toneous enlf)' 's !ound in theCef!liicale and r am told !l~'the P"-'I&.D<:to smd the certIficate back fOfeOTTectioTVcanell.l1Ion,Ishall do so im:r.edla:ely
~nd ~hall rlQ( take any bendi: onhe error, Abo\'e mi(lrrnatil'ln i~
COTTlXlandnothing hu been concealed and lffound false Ofeontrary to above, I shall be hallIe for
necessary aelHln by the C('lunc11which ma)'lead to caneellaticn "fmy registration with PM&.DC. I tak.: full responsibll\t)' 0~3ulhenfielly of documents submincd
~Io"gWilli this ilpphcatlon

Name

Date

Signarure
Cdl/

E-mail(Essential)

Phone --------------------

C;'\IC

:-':0.

(rOr office use only)

Recetved Rs.
Keistr.'llion renewed

AsslstarH

(Rupees

) Vide rceeipi t-,"o.

& valid upto

on

Superintendent

:\ssistanIlDepu:y

~dateet

------

JI,D Card is..<;ucdr.'-Jot issued

Reglslrar

Registrar

l::<; f:N E RA L
i.

ii.
iii.
iv

v.

vi.

Attestation:
Copy of MBRSfHDS degree, Postgraduate Degree/Diploma
duly attested by the PrincipaLNice
Principal IDeanlProfessor/Associate/Assistant
Professor of McdicallDencal College of Pakistan recognized by
rM&DC. Medical Superitendent/Commandant
of recognized teaching hospital, Commanding
Officer (Anny
Medical Corps), EDOHIDHO or authorized officer of Pakistan Embassy abroad. (Mandatory requirement if not
submitted earlier. (Stamp of the artcstcrmust show his/her name, designation and present working place).
If the required documents are not properly attested and attached with this application it shall not be entertained and
shall be returned unaclioned.
Doctors coming personally and intending to get their Registration Certificate on Urgent basis are advised to deposit
their documents
before
10:00 a,m. if courier
service
is required,
fee may be paid accordmgly
The certificate can be mailed by PM&DC or the applicant doctor can collect the Registration Certificate
personally or waugh an authorized person having an authority letter by applicant his identity and
must be in possession of the anginal bank receipt and copy of his/her Cl\'IC.
For any additional qualification not already registered use PM&DC Form vi or "ii.
For foreign nationals purpose letter required from the concerned instilUtion

2- FEE SCHEDULE FOR RETENTION

Basic Medical !Dental Qualification MBBS/EDS.
Rs. 500/- per annum
ii. Basic McdicallDental
Qualification MBBSfBDS with additiunal pustgraduate
qualifications
Rs 700/- per annum
iii Relention Fce for Foreign Nationals (for one year)
Rs 1000/.
IV.
Late Fee (Will he charged if renewed after Il lapse of the six months grace period
after the expiry date of Registration Certifieate).Plus Rs. SOO/-per year for the continuing years. Rs. 1000.1.
For any change in registration certificate
Rs. 2000.1.
v.
vi. For exteruion of provisional registration.
R.5. 1500/vii.
URGE1'o'T fEE
(for processing on prioriry within three working days)
Rs. 1000/viii.
COURIER FEE
(with in Pakistan)
Rs. 150/(out side Pakistan) _
Rs. 1500/- (subject to change in rales)
ox.
Fee for v~rificatlon / attestation of registranon
Rs 1000'.
Late fee
Rs. 1000/-

,.

For~ign \'ntioni1ls 8.: Pakistani Doctors

directly vide mAN

Pakistani

arr1ying

li'olll foreign cOLlnlri~s call

ptl)'

fee online

to PM&DC Account

PK43 UNIL 0109 0002 0003 1378 United I30nk Limited (UI31.). The Ice should be in only

Rupees and send the reference numb ....!' of tile lC~ dcpm:itcd online to PM&DC \',1ith :-'ourdocumelllS.

3-1:"1 CASE OF LOSSJ!\HSPLACE:\lENT_OF

~EGISTRATIQS
VALIn CERTIFICATE
rleas~ use PM&DC
(for expircd certificate only bank dratl Rs. 2nOOJ- as duplicare fee & an affidavit on Rs. 20/- stamp paper.)(Speciman

form viii
~ven below)

4- If change of name after marriage is required, please send attested photocopy of Nikanh Nama OR Alfidavil (specimen
given below) along with a fee of RS.2000J-.
5- Any false mfonnatlon

given herein shall make the applicant liable for cancellation of P:-.1DC registration

SPEcnlEN

OF AFFIDAVIT ON STAMP PAPER OF RS.201-

FOR FOR LOSS OF REGISTRATION

Dr.

SonID/of

--------

declare

CERTIFICATE.

Present Address

___ Permanent

Addrcss

lb Oath as under.

I) That I was registered

by the Pakistan

Medical & DenIal Council at Registration

2) That have I tride may best to trace out my registration

3) The certificate
bc misused

will be returned

:"la.

dated the

but the same could not be traced up till now_

Pakistan Medical &: Dental Council

Islamabad,

If at any time future and will not

with my concurrence.

~) The above statement

Signature

10 Registrar,

certilicate

is correct to the best of my knowledge

and nothing has concealed

or suppressed

by me in this behalf
Deponent

and Seal of the court

SPECIMEN OF AFFIDAVIT ON STAMP PAPER OF RS.201FOR TilE CIIANGE NAME AFTER MARRIAGE AFFIDAVIT
I Dr.

D/O of

Do hereby solemnly
Council

alfmn

as Dr.

(Documenlary

Now II am married to
proof attached

i.e Nikah Nama/Govt.

name a.<;gIven above. The above statement

suppressed

Presenl Address

and declare on oath that before my marriage

notification)

. _ and

Permanent
I was registered

r have

Therefore

adopted

Addrcss

with thc Pakistan

my married

& Dental

bane as Dr.

I may be issued regisrration

is correct to the best of my knowledge

_
Medical

and belief and nothing

ceniticate

~
in my mamed

has been conccaled

by name in this behalf.

Signarurc

and Seal of the court

Deponent

or