Application for
Renewal Of Registration
with the
Maharashtra Medical Council, Mumbai
Application No :
MMC20240001849
Date :
12/01/2024
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)
HILE PRAKASH NAMDEO
Registration No:
2009020154
Registration Date :
03/02/2009
Valid upto Date :
03/02/2029
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.
HILE
PRAKASH
NAMDEO
Name of Father
:
Mr.
Name of Mother
:
Mrs.
In Case of Married Women
Maiden Name
:
-
RESEDENTIAL ADDRESS
:
A-704, REGENCY PARADISE, GAURPADA ROAD, OPP. SHUBHAM COMPLEX, MILIND NAGAR, KALYAN WEST, KALYAN, THANE
City
:
KALYAN
District
:
THANE
State
:
MAHARASHTRA
Country
:
INDIA
Pincode
:
421301
Date of birth
:
27/09/1978
Tel No (Res)
:
Clinic No
:
Mobile No
:
8451802818
Email Id
:
prakash78hile@gmail.com
Total Obtained Credits Points
:
40
Remaining Credits Points
:
0
Qualification Details
Details of Qualification
Name of College
University
Passing Year
Certificate No
Certificate Date
1.
M.B.B.S.
RGMC THANE
MUMBAI UNIVERSITY
2008
Pariticulars Of Payment
Payment Mode
:
Online Payment
Receipt No
:
0781891011
Receipt Date
:
16/01/2024
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 :
12/01/2024
Applicant signature
NOTE:- You do not need to submit the print out of original submitted Renewal Application form to MMC office.