Application for Renewal Of Registration   with the
Maharashtra Medical Council, Mumbai
Application No :  MMC201841164 Date : 26/10/2018
To,
Registrar ,
Maharashtra Medical Council ,
189/A, Anand Complex, 2nd Floor,
Sane Guruji Marg, Arthur Road Naka,
Chinchpokali (W), Mumbai - 400 011.
 
Sub: Dr  (Smt/Shri)  GOHATRE ASHVINI MOHAN
Registration No:  2008103697   Registration Date : 22/10/2008   Valid upto Date :22/10/2028
Sir,
I the undersigned applicant, request yoy that my name may be continued on the Register of Medical Practitioners maintained by the Maharashtra Medical Council as per 23 (a)/23 (c) of MMC Act 1965 and amendment 2003. My particulars are as Follows :
Name of Applicant : Ms. GOHATRE ASHVINI MOHAN
Name of Father : Mr. GOHATRE MOHAN BHIMRAO
Name of Mother : Mrs. GOHATRE REKHA MOHAN
In Case of Married Women
Maiden Name : -

RESEDENTIAL ADDRESS : C/O MR. M.B. GOHATRE, SHYAM NAGAR, AMRAVATI
City : AMRAVATI District : AMRAVATI
State : MAHARASHTRA Country : INDIA
Pincode : 444606
Date of birth : 22/07/1982 Tel No (Res) : Clinic No :
Mobile No : 8888445775 Email Id : ashugohatre@gmail.com  
Total Obtained Credits Points : 30
Remaining Credits Points : 0
Qualification Details
 Details of QualificationName of CollegeUniversityPassing YearCertificate NoCertificate Date
1.M.B.B.S.JNMC, WARDHAMAHARASHTRA UNIVERSITY OF HEALTH SCIENCES, NASHIK2008  
2.Dip. (Gynae. & Obst.)C.P.S. MUMBAIC.P.S. MUMBAI20154172/201819/12/2018
Pariticulars Of Payment
Payment Mode : Online Payment
Receipt No : IGAEQKFOA2
Receipt Date : 29/10/2018
   I have uploaded following documents:
1.Latest Passport size Photograph
2.Self attested photocopy of MMC Registration Certificate
3.Original Undertaking
4.Self attested photocopy of Aadhar Card
DECLARATION (Registered Medical Practitioner)
I shall abide by the Code of medical Ethics as enunciated in the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002.
Date : 26/10/2018
    Applicant signature               


NOTE:- You do not need to submit the print out of original submitted Renewal Application form to MMC office.