Application No :  MMC20230055434	Date : 25/08/2023
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)  KAVALE HRUSHIKESH VILAS
Registration No:  2018084193   Registration Date : 13/08/2018   Valid upto Date :13/08/2028
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	:	Mr.	KAVALE	HRUSHIKESH	VILAS
Name of Father	:	Mr.
Name of Mother	:	Mrs.
In Case of Married Women
Maiden Name	:	-

RESEDENTIAL ADDRESS	:	VIJAY HOSPITAL,OPPOSITE PHC,A.P MIRAJGAON TAL. KARJAT DIST. AHMEDNAGAR
City	:	KARJAT	District	:	AHMEDNAGAR
State	:	MAHARASHTRA	Country	:	INDIA
Pincode	:	414401

Date of birth	:	20/11/1994	Tel No (Res)	:		Clinic No	:
Mobile No	:	8600321188	Email Id	:	hrushikavale@gmail.com

Pariticulars Of Payment
Payment Mode	:	Online Payment
Receipt No	:	0715685385
Receipt Date	:	30/08/2023

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 : 25/08/2023

Applicant signature