Amendment status not verified — confirm the current text below against the official source.
Present Occupation 9 No. I submit herewithorid certificates for vedicationand submit attestedcopies of the same certificates: (a) Two recent passport size photographs with name and signature at the backside. (b) Nagaland Medical Council Registration Certificate (c) MBBS DegreeIPost Graduate Degree/DiplomalPost-Doctoral Degree Certificate. I hereby submit a Bank Draft No ........................ Dated ................... prepared .................... from (Bank) for Rs 1000/- (Rupees One Thousand) as non-refundable fee in favour of 'Nagaland Medical Council' (in case of late fee) Description of Qualijication I hereby submit a Bank Draft No ..................... Dated ................. Prepared from (Bank) ...................... for Rs .......................................... Being the late fee as non-refundable fee in favour of 'Nagaland Medical Council' Name of the School/ College! Medical Institution examinaton Name of the BoardlLTnive- rsityficensing Body passing Year of completion of Internship in any other case year of DECLARATION I solemnly affirm and declare that the particulars furnished above by me are true to the best of my knowledge and belief and I undertake to abide by the code ofconduct &Ethics ofNagaland Medical Council and IndianMedical Council and by the Rules ofNagaland Medical Council Date: Signature of the Applicant (For office use only) Received the above documents in on&. Signature of registered person ............. Name ...................................................... Date ........................................................ FORM 4 FORM FOR GENERAL NOTICE General Notice is hereby given to all Registered Practitioners included in the State Register ofnagaland Medical Council under the Nagaland Medical Council Act, 201 4 whosevalidation of Registration i.e. 5 years have been completed, they have make an application to theRegistrar for continuance of their name inthe said Register as provided in Rule ofNagaland Medical Council Rules, 2014. Individual notices along with the prescribed fiom of application are being sent under Certificate of posting to evety suchregistered Practitioner to the address in the said Register. An application in Form-2 for continuation of the name in the Register should be rehuned to the undersigned duly completed within 45 days of the issue ofthe notice. Any Registered Practitioner not receiving the form by post may obtain it fiom the Register. Date: Yours faithfdly Registrar, Nagaland Medical Council, Nagaland FORM - 5 Notice for continuation of Name of the Register To, Dr. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sub: Individual Notice for continuation of name in theNagaland Medical Council Register Sir, Notice is hereby given to you calling upon to return the enclosed application form (FormNo -2) duly filled in by you to the Registrar within 45 (forty five days) for continuation of your name in the State ofNagaland Medical Council. Yours fa* Registrar, Nagaland Medical Council, Nagaland FORM - 6 APPLICATION FOR REGISTRATION OF ADDITIONAL QU~rnCATION Receipt no.. .......... Date. .................. (for office use) passport Size photograph attested The Registrar, Nagaland Medical Council Sub: Registration of additional quaMcation Sir, I am aregistered practitioner ofNagaland Medical Council and my Registration No is ........................................................................................... I have acquired an additional qualification in modem system of medicine and desire to register the same. My particulars are as under Name of the Applicant (block letters) Father's /Husband's Name Mother's Name Gender Dater of Birth(date month, year) Nationality Category (General IAPST) Address a. Residential Address b. Permanent Address c. ProfessionalAddress 9 TelephoneNo.NobileNo./Fax. No./Email ID lo. Details of QuaUications I hereby submit aBank Draft .................................. No ........................................... Dated. Obtained from (Bank) .............................................. for Rs 5001- (Rupees Five Hundred) non- refundable fee in favour ofNagaland Medical Council. DECLARATION Year of obtammg the quaWication I solemnly affirm and declare that the particulars furnished by me are true to the best of my knowledge and belief and I undertake to abide by the code of conduct& Ethics of Nagaland Medical Council and IndianMedical Council and by the Rules of Nagaland Medical Council. Name of the University/ Licensing body Date Signature of the Applicant Name of the College1 Medical of Institution Sl No. Description of QuaWCation Note: