Application for
Renewal Of Registration
with the
Maharashtra Medical Council, Mumbai
Application No :
MMC20230042276
Date :
29/06/2023
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)
ADITI PANDEY
Registration No:
2018040901
Registration Date :
11/04/2018
Valid upto Date :
11/04/2028
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.
ADITI
PANDEY
Name of Father
:
Mr.
Name of Mother
:
Mrs.
In Case of Married Women
Maiden Name
:
-
RESEDENTIAL ADDRESS
:
F1/07 FRIENDS RESIDENCY, SARKANDA, TAL. DIST. BILASPUR
City
:
BILASPUR
District
:
BILASPUR
State
:
CHHATTISGARH
Country
:
INDIA
Pincode
:
495006
Date of birth
:
02/06/1991
Tel No (Res)
:
09424140558
Clinic No
:
Mobile No
:
9503827087
Email Id
:
aditi.77pandey@gmail.com
Total Obtained Credits Points
:
0
Remaining Credits Points
:
30
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
2018
Pariticulars Of Payment
Payment Mode
:
Online Payment
Receipt No
:
202318089195382
Receipt Date
:
30/06/2023
I have uploaded following documents:
1.
Latest Passport size Photograph
2.
Self attested photocopy of MMC Registration Certificate
3.
Original Undertaking
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 :
29/06/2023
Applicant signature
NOTE:- You do not need to submit the print out of original submitted Renewal Application form to MMC office.