Application for
Renewal Of Registration
with the
Maharashtra Medical Council, Mumbai
Application No :
MMC202261781
Date :
02/04/2022
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)
NAIR RADHIKA RADHAKRISHNAN
Registration No:
2017040877
Registration Date :
05/04/2017
Valid upto Date :
05/04/2027
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.
NAIR
RADHIKA
RADHAKRISHNAN
Name of Father
:
Mr.
NAIR
RADHAKRISHNAN
VELAYUDHAN
Name of Mother
:
Mrs.
NAIR
SHOBHA
RADHAKRISHNAN
In Case of Married Women
Maiden Name
:
-
RESEDENTIAL ADDRESS
:
504, GANESH DARSHAN CO SOCIETY, NAHUR EAST, BHANDUP, MUMBAI-
City
:
MUMBAI (URBAN)
District
:
MUMBAI (URBAN)
State
:
MAHARASHTRA
Country
:
INDIA
Pincode
:
400042
Date of birth
:
13/01/1994
Tel No (Res)
:
8884735969
Clinic No
:
8884735969
Mobile No
:
8007736533
Email Id
:
radhika.rnair@hotmail.com
Total Obtained Credits Points
:
23
Remaining Credits Points
:
7
Qualification Details
Details of Qualification
Name of College
University
Passing Year
Certificate No
Certificate Date
1.
M.B.B.S.
JAWAHARLAL NEHRU MEDICAL COLLEGE,SAWANGI (MEGHE),WARDHA
DATTA MEGHE INSTITUTE OF MEDICAL SCIENCES DEEMED UNIVERSITY, WARDHA
2017
Pariticulars Of Payment
Payment Mode
:
Online Payment
Receipt No
:
202209289518948
Receipt Date
:
04/04/2022
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 :
02/04/2022
Applicant signature
NOTE:- You do not need to submit the print out of original submitted Renewal Application form to MMC office.