Application for Renewal Of Registration   with the
Maharashtra Medical Council, Mumbai
Application No :  MMC202232695 Date : 05/02/2022
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)  PANSE PALLAVI RAVINDRA
Registration No:  2004083101   Registration Date : 25/08/2004   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 : Mrs. PANSE PALLAVI RAVINDRA
Name of Father : Mr.
Name of Mother : Mrs.
In Case of Married Women
Maiden Name : Ms.

RESEDENTIAL ADDRESS : 10/73, AGARKAR NAGAR,DIST-PUNE
City : PUNE District : PUNE
State : MAHARASHTRA Country : INDIA
Pincode : 411001
Date of birth : 28/03/1981 Tel No (Res) : Clinic No :
Mobile No : 9370911222 Email Id : pallavipanse28@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.DR.D.Y.PATIL MEDICAL COLLEGE, HOSPITAL AND RESEARCH CENTRE,PIMPRI,PUNEMAHARASHTRA UNIVERSITY OF HEALTH SCIENCES, NASHIK2004  
2.Dip. (Gynae. & Obst.)CPS,BOMBAYC.P.S. BOMBAY20070730/200805/03/2008
3.M.S.(Obst. & Gynae.)MGMMC, NAVI MUMBAIMGM INSTITUTE OF HEALTH SCIENCES (DEEMED UNIVERSITY), NAVI MUMBAI20091046/201612/05/2016
Pariticulars Of Payment
Payment Mode : Online Payment
Receipt No : 202203679602487
Receipt Date : 08/02/2022
   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 : 05/02/2022
    Applicant signature               


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