E-mail : telanganamedicalcouncil@gmail.

com Phone : 65577343, Fax : 040-24657639

Website : www.tsmconline.in

TELANGANA STATE MEDICAL COUNCIL

DM & HS CAMPUS, SULTAN BAZAR, HYDERABAD - 500 095.

Application for issue of Goodstanding Certificate PHOTO

From :18-1-350/11/30, Gulshan Iqbal Colony

Chandrayan Gutta, Hyderabad - 500005
Dr. Lubna Sultana To,
The Registrar,
T.S. Medical Council,
My Date of Birth : 07/02/1988 Sultan Bazar,
Hyderabad - 500 095.
Mother's Name : Parveen Sultana
E-mail ID : drlubnasultana@yahoo.com

Blood Group : B - Positive

Cell No. : 9848442292

Sir,
Sub : Issue of Goodstanding Certificate
Ref APMC/FMR/92893
: My Registration No. .......................

Lubna Sultana
I under signed Dr. ...................................................................................................................
Saleha Salama Sadi
S/o. / D/o. ..........................................................................................................................has registered
APMC/FMR/92893
with AMC / HMC / TSMC under Registration No...........................................on 09/07/2015
....................................

The copy of said certificate is enclosed herewith for perusal. I request to kindly issue me a Goodstanding
Certificate which is required for my use in abroad. The necessary fee of Rs. 5,000/- is paid herewith.
Please accept the same and issue me the Goodstanding Certificate as early as possible.

Yours faithfully,

Lubna Sultana
(Dr. ..............................................)

Enclosures :

1. Copy of the Medical Registration Certificate.

2. D.D. for Rs. 5,000/- drawn in favour of "Telangana State Medical Council, Hyderabad"
from Andhra Bank only.
3. In case of Tatkal Additional Fee Rs. 2,000/- if submitted before 1-00 p.m.
D.D. No. Dt. Rs.
SPECIMEN SIGNATURES

1) 2) 3)

REGISTRAR