PUNJAB DENTAL COUNCIL

Medical Education Bhawan(3rd Floor) Sector-69, S.A.S.Nagar(Tel.0172-5197531)

Website: www.punjabdentalcouncil.com Email: punjabdentalcouncil@gmail.com

FORM FOR RENEWAL OF REGISTRATION

(To be filled in by the candidate)

1. Name of Doctor :_________________________________________________

(In Block Letters only)
2 Registration No. :_________________________________________________

3 Date of First Registration :_________________________________________________

4 Father’s Name :_________________________________________________

5 Mother’s Name :_________________________________________________

6 Qualification (BDS/MDS) :_________________________________________________

Name of College & Univ.
_________________________________________________
_________________________________________________
7 Date of Birth :_________________________________________________

8 Birth Place :_________________________________________________

9. Nationality :_________________________________________________

10 PAN Number :_________________________________________________

11 Residential Address :_________________________________________________

_________________________________________________

12 Professional Address :_________________________________________________

_________________________________________________

13 Mobile No.& Tel. No. :_________________________________________________

14 E-mail Address :_________________________________________________

15 Domicile Status :_________________________________________________

(India/Foreign)
16 Date of Last Renewal :_________________________________________________

Dated:_________________ Signature of the Applicant.

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Instructions regarding Renewal of Registration:-

1. The Dentists can pay their renewal fee under “Renewal” Section by Login into their
account/profile on website of Punjab Dental Council i.e.www.punjabdentalcouncil.com :-

Step 1 - Go to website of Punjab Dental Council i.e.www.punjabdentalcouncil.com

Step 2 - login using username and password.
Step 3 - Go to Renewal section.
Step 4 - fill up required information and proceed to pay.

2. The applicant can also come personally for his/her renewal of registration, along with
Original Registration Certificate.

3. In case a Dentist cannot come personally, he / she can submit his / her Form for renewal,
with renewal fee, by post or through someone, with photocopy of Registration Certificate.

4. Fee can be deposited in cash or Bank Draft favoring “Registrar Punjab Dental Council”
payable at Chandigarh @ 200/- per year (plus late fee @ 500/- per year if registration
is not renewed till 31st March).

Entry of renewal of registration will be made only on Original Registration Certificate.

5. The Dentists applying from foreign countries can also go for online renewal and can pay
renewal fee as mentioned above at Sr. No. 1.

6. Any change in his/her Permanent address should be intimated to the Registrar Punjab
Dental Council by sending separate request with this Form.

7. Timing for payment of fee: 9:00 A.M. to 01:00 P.M. and 2:00 P.M. to 3:00 P.M. on any
working day.

8. After renewal, original Registration will be issued after 3 Working Days