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NMC Registration Form Details

The document is a form from the National Medical Commission designed to collect personal and professional information from medical practitioners. It includes sections for basic identification details, educational qualifications, registration information, and current employment details. The form requires signatures and various identifiers such as Aadhaar number and contact information.

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ansariabdal7
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95 views2 pages

NMC Registration Form Details

The document is a form from the National Medical Commission designed to collect personal and professional information from medical practitioners. It includes sections for basic identification details, educational qualifications, registration information, and current employment details. The form requires signatures and various identifiers such as Aadhaar number and contact information.

Uploaded by

ansariabdal7
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

NATIONAL MEDICAL COMMISSION

FORM
Sno Information to be Collected Comments

01. Name As given in MBBS Degree

Recent
02. Father's Name Phonograph

03. Present Address/ Correspondence

04. Permanent Address

05. Aadhaar Number

06. Phohe (Mobile)Landline

07. E-Mail Fax Alternate E-Mail id if


available may be given

08. Date of Birth

09. Nationality
10. UG Degree
1. Name of the degree
2. Name of Medical Collge/University
3. Month & Year of Passing
4. Registration Number
5. Date of Registration
6. Name(s)of the register
(National/ State)
7. Whether the registration is
renewable of Permanent
12. A. PG Degree ([Link])
1. Name of the degree
2. Narne of Medical Collge/University
3. Month & Year of Passing
4. Registration Number
5. Date of Registration
6. Narne(s) of the register
(National/ State)
7. Whether the registration is
renewable of Permanent
B. PG ([Link])
I. Name of the degree
2. Name of Medical Collge/University
3. Month & Year of Passing
4. Registration Number
5. Date of Registration
6. Name(s) of the register
(National/ State)
7. Whether the registration is
renewable of Permanent
C. PG (DNB From NBD)
1. Name of the degree
2. Name of Medical Collge/University
3. Month & Year of Passing
4. Registration Number
5. Date of Registration
6. Name(s) of the register
(National/ State)
7. Whether the registration is
renewable of Permanent
D. PG (Medical Diploma)
1. Name of the degree
2. Name of Medical Collge/University
3. Month & Year of Passing
4. Registration Number
5. Date of Registration
6. Name(s) of the register
(National/ State)
7. Whether the registration is
renewable of Permanent
[Link] Speciality (DM/[Link])
1. Name of the degree
2. Name of Medical Collge/University
3. Month & Year of Passing
4. Registration Number
5. Date of Registration
6. Name(s) of the register
(National/ State)
7. Whether the registration is
renewable of Permanent
Name of the Institure/Hospital/Clinic 1. Government/ Private/ Own/ Other
13. where engased in 2. Teaching/ Non Teaching
Teaching/ Research/ Practice of Medicine 3. Research/ Non Research
Complete Address/ Contact Details of the
14. Institute/ Hospital/ Clinic mentioned
in item 13 above
Name of person in Hospital/ Institute
Mentioned in item on-13 above who is
15. responsible for legal issued regarding
patient care provided by the doctor

16. Registered Medical Practioner (RMP)


no. of the person mention in item no-15

Signature of Candidate

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