1/29/24, 3:10 PM Madhya Pradesh Medical Council

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Additional Registration Form For P.G. Qualification

* Fields are mandatory

Personal Details
ADD2407217

Applicant's Name * Satish Kumar Shahu

Father's Name * Parashu Ram Shahu Mother's Name * Jagpatiya Devi

Date Of Birth (DD/MM/YYYY) 29/08/1994 Age(As on date) 24 years, 8 months,

13 days

Category * Unreserved Gender * Male

Nationality* Indian Mobile No. * 7804079082

Email-Id * kumarsatishshahu@gmail.com Domicile of M.P. * YES

Registration Details:
Permanent Reg No. Of MP-24975 Date Of Registration 21/08/2019
MPMC * (DD/MM/YYYY) *

Name Of Medical Council* Madhya Pradesh Medical Council

Academic Details

Primary medical qualification (MBBS):

Month Of Exam * March Year Of Exam * 2018

University * Barkatullah University,Bhopal College * Gandhi Medical

College, Bhopal

Internship Completion Date 30/03/2019 Roll Number (MBBS) * 14184166

(DD/MM/YYYY) *

Medical Qualification * MBBS

P.G. Medical Qualification (fill only Recognized Qualification)

Name Of P.G. Degree or Diplomate N.B. (Gen. Med.) University Name National Board of
Diploma Examination, New
delhi

College Name National Board Of Examination New Month Of Exam April

Delhi

Year Of Exam 2023 P.G. Roll Number 2311111601

State Of P.G. Degree NMP Is Your P.G. Degree NO

registered With other state
medical council

Date Of Result Of PG 31/10/2023

Diploma/Degree

Address:
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1/29/24, 3:10 PM Madhya Pradesh Medical Council

Current/Correspondence Room No 71, F-Block, GMC Boys Hostel, Hamidia Hospital, Bhopal 462001 Bhopal Bhopal
Address* Madhya Pradesh 462001

State* MADHYA PRADESH District * BHOPAL

City* Bhopal Pin Code * 462001

Permanent Address * Room No 71, F-Block, GMC Boys Hostel, Hamidia Hospital, Bhopal 462001 Bhopal Bhopal
Madhya Pradesh 462001

State * MADHYA PRADESH District * BHOPAL

City * Bhopal Pin Code * 462001

Upload Documents *

S.N Document Description

1 Permanent Registration Certificate *

2 P.G. Degree or Diploma *

3 Passing or Attempt Certificate issued by

Dean Concerned Medical College *

4 Affidavit(disclaimer) on prescribe format

*

5 Additional Registration Certificate (If

Diploma/Degree already registered in
Other State Medical Council, kindly upload
a single file for all related Additional
Registration Certificate)

Fee Details *
Fee 3400 Late Fee 0

Portal Charge 50 Total Fee 3450

Photo & Signature: *

Declaration *
I undertake that documents and declarations submitted by me if found false, fabricated or otherwise tampered with
then Council shall, cancel my registration of additional qualification and shall proceed for taking action against me in
accordance with law.

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