Application for Renewal Of Registration   with the
Maharashtra Medical Council, Mumbai
Application No :  MMC202203967 Date : 04/01/2022
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)  GALDHAR ASHWINI NIVRUTTI
Registration No:  2001021003   Registration Date : 26/02/2001   Valid upto Date :28/02/2027
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. GALDHAR ASHWINI NIVRUTTI
Name of Father : Mr.
Name of Mother : Mrs.
In Case of Married Women
Maiden Name : -

RESEDENTIAL ADDRESS : B-302, ARCHIT RUTURANG APARTMENT, OPP NAKSHTRA LAWNS, PIPELINE ROAD, OFF GANGAPUR ROAD, NASHIK
City : NASHIK District : NASHIK
State : MAHARASHTRA Country : INDIA
Pincode : 422013
Date of birth : 21/07/1978 Tel No (Res) : Clinic No :
Mobile No : 9881301808 Email Id : asp1404@gmail.com  
Total Obtained Credits Points : 35
Remaining Credits Points : 0
Qualification Details
 Details of QualificationName of CollegeUniversityPassing YearCertificate NoCertificate Date
1.M.B.B.S.BJMC PUNEPOONA UNIVERSITY2001  
2.Dip. (Obst. & Gynae.)GSMC MUMBAIMUMBAI UNIVERSITY20050444/201203/02/2012
3.F.C.P.S. (Mid. & Gynae.)C.P.S.BOMBAYC.P.S. BOMBAY20060446/201203/02/2012
4.D.N.B. (Obst. & Gynae.)N.B.E. NEW DELHIN.B.E. NEW DELHI20130589/202321/02/2023
Pariticulars Of Payment
Payment Mode : Online Payment
Receipt No : 202200406906902
Receipt Date : 05/01/2022
   I have uploaded following documents:
1.Latest Passport size Photograph
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 : 04/01/2022
    Applicant signature               


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