Application for Renewal Of Registration   with the
Maharashtra Medical Council, Mumbai
Application No :  MMC20240007410 Date : 16/02/2024
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)  SANT SANJITKUMAR MORESHWAR
Registration No:  2009020295   Registration Date : 18/02/2009   Valid upto Date :18/02/2029
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. SANT SANJITKUMAR MORESHWAR
Name of Father : Mr. SANT MORESHWAR ASARAM
Name of Mother : Mrs. SANT MANGAL MORESHWAR
In Case of Married Women
Maiden Name : -

RESEDENTIAL ADDRESS : FLAT NO A1/403 MILLENNIUM PARK MIDC CHIKALTHANA
City : AURANGABAD District : AURANGABAD
State : MAHARASHTRA Country : INDIA
Pincode : 431006
Date of birth : 09/05/1985 Tel No (Res) : 9923217771 Clinic No : 9923217771
Mobile No : 9923217771 Email Id : sanjitsant@gmail.com  
Total Obtained Credits Points : 59
Remaining Credits Points : 0
Qualification Details
 Details of QualificationName of CollegeUniversityPassing YearCertificate NoCertificate Date
1.M.B.B.S.GOVT. MC. AURANGABADMAHARASHTRA UNIVERSITY OF HEALTH SCIENCES, NASHIK2009  
2.M.S.(Genl. Surg.)GRANT MEDICAL COLLEGE, MUMBAIMAHARASHTRA UNIVERSITY OF HEALTH SCIENCES, NASHIK20173115/201721/09/2017
Pariticulars Of Payment
Payment Mode : Online Payment
Receipt No : IGAQWHAFK1
Receipt Date : 17/02/2024
   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 : 16/02/2024
    Applicant signature               


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