SRI LANKA MEDICAL COUNCIL

APPLICATION FOR INCLUSION IN REGISTER OF DENTAL SPECIALISTS

1. Full name of the applicant:

2. Address:

3. Gender: Female Male (double click relevant box)

4. Citizenship: (double click relevant box) Sri Lankan Other Dual citizen

If other, specify

5. Contact telephone numbers:

6. National Identity Card Number:

7. E-mail address:

8. Current SLMC registration

a. Registration Number:

9. Primary qualifications:

a. Name of qualification:

b. Name of awarding institution:

c. Year of award:

10. Qualification to be considered for inclusion in Specialist Registry

a. MD and Board Certification from PGIM? Yes No

If yes,

i. MD in

ii. Date of passing MD examination: (dd/mm/yyyy)

iii. Board Certification as a Specialist in:

iv. Date of Board Certification: (dd/mm/yyyy)

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 b. Qualification other than MD and Board Certification from PGIM: Yes No

If yes,

i. Field of Specialization:

ii. Name of university / institute awarding specialist qualification:

iii. Is this qualification recognized as a specialist qualification in the country of

award? Yes No

iv. If yes, state country and registering authority:

v. Date of certification as a specialist: (dd/mm/yyyy)

I certify that the information given above and the documents submitted by me are accurate

and true.

Date: ........................... Signature of Applicant: .....................................

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Instructions

A. Documents to be submitted as Follows

1. Duly completed and signed application

2. The fee for ‘REGISTER OF MEDICAL SPECIALISTS’ is Rs. 11,500/=, which should be

credited to the Account of the Sri Lanka Medical Council A/C No 0000371208 (Bank of

Ceylon, Maradana Branch). Please ensure whether your NIC No and relevant payment

category (LS-Dental) were entered by the Banking Officer for future clarifications. The

Bank Credit Slip (Green) should be attached with the application.

3. PGIM Board Certification (original + photocopy) or for those who have non-Sri

Lankan specialist qualifications, the certification as a specialist (original + photocopy)

4. National Identity Card or business pages of currently valid passport (original +

photocopy)

5. If the name in any of the above certificates (under items 3 or 4) is different from that

under which the applicant is already registered with the SLMC, a letter from the

authority issuing the Specialist Certification, endorsing that he / she is one and the

same person and an affidavit signed by the applicant and certified by a Justice of

peace endorsing that he / she is one and the same person.

B. Notes

1. The Sri Lanka Medical Council maintains a Register of Specialists under the provisions
of the Medical (Amendment) Act No 28 of 2018, in order to inform the public of medical
and dental professionals with specialist qualifications.
2. Only Medical and Dental Specialists who are eligible to be registered by the SLMC under
Section 39A of the Medical Ordinance (as amended) will be considered.
3. The criteria for inclusion, as set out in Section 39A of the Medical Ordinance (as
amended) are as follows:
a. A medical practitioner registered under Section 29 of the Medical Ordinance, who
possesses a qualification required for Specialist Medical Officer Grade, as specified in
the Medical Service Minutes published in Gazette No 662/11, dated May 17, 1991

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 and amended from time to time, the last being in Gazette no 1883/17, published on
October 11, 2014; or
b. A dentist registered under Section 43 of the Medical Ordinance, who possesses a
qualification required for Specialist Medical Officer Grade, as specified in the
Medical Service Minutes published in Gazette No 662/11, dated May 17, 1991 and
amended from time to time, the last being in Gazette no 1883/17, published on
October 11, 2014, or
c. A medical practitioner registered under Section 29, or a dentist registered under
Section 43, who has completed specialist training in a country other than Sri Lanka,
whose specialist qualification satisfies the eligibility criteria of the Postgraduate
Institute of Medicine of the University of Colombo and is issued a Certificate of
Accreditation in respect of Board Certification by the PGIM or
d. Any person who has obtained a basic medical or dental qualification from an
institution, in a country other than Sri Lanka, which is recognized by the SLMC, and
whose specialist qualification satisfies the eligibility criteria of the PGIM and is
issued a Certificate of Accreditation in respect of Board Certification by the PGIM.
4. All applicants are required to provide proof of Board Certification from the PGIM (those
falling under items 3a and 3b above) or proof of award of equivalent qualifications and
having held posts as specialists (those falling under items 3c and 3d above).
5. Applications made under Item 3c and 3d above will be referred to the PGIM by the
SLMC for consideration by the PGIM’s Accreditation Committee. Such applicants shall
be required to pay a fee to be determined by the PGIM for issuance of a Certificate of
Accreditation.
6. The specialist categories recognized at present are listed in the Annexure
7. Once the application has been approved by the SLMC, a certificate confirming inclusion
of the applicant’s name in the Register of Medical / Dental Specialists will be sent under
registered cover to the address recorded in the SLMC Register.

Registrar, Sri Lanka Medical Council

31, Norris Canal Road
Colombo 10

Tel no: 011 2691848 Email: info@mc.lk

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Fax no: 011 2674787 website: www.srilankamedicalcouncil.org / www.mc.lk

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Sri
Lanka Nominating a Person to Collect Documents
Medical
Council
Only SLMC registrants having an SLMC ID card can be nominated to collect certificates and ID
cards on behalf of the registrants.

Registrant’s details
Category:
Registration No.:
Name:

Nominated person’s details

Category:
Registration No.:
Name:

Description of documents to be collected

1.
2.
3.
I am authorizing the above-nominated person to collect the above documents on my behalf. I know
Sri Lanka Medical Council will not be responsible for any loss or damage of documents after collection
from SLMC.

Signature of the proposer Signature of the nominee

Date:

Please attach the nominated person’s photocopy of the SLMC ID card. No document will be issued
without the SLMC ID of the nominee.

To be completed at the time of collecting documents from SLMC

I have received the undamaged documents listed above and will be handing them to the proposer as
soon as possible.

Signature of the nominee Initials of the SLMC staff

Date
 Instructions
• The Sri Lanka Medical Council advises the registrants to collect their documents from the SLMC
Offie.

• Under exceptional circumstances, the registrants may nominate an SLMC registered person to
collect their documents on their behalf by furnishing this nomination form.

• The SLMC is not responsible for lost or damaged documents once dispatched or handed over.

• The SLMC will not replace lost or damaged documents.

The SLMC would issue duplicates or extracts of lost or damaged documents, whichever is
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applicable.

Registrar
Sri Lanka Medical Council
31 Norris Canal Road
Colombo 10
Website: www.slmc.gov.lk
Email: Info@slmc.gov.lk
Telephone: +94112691848
Fax: +94112674787