Application for Renewal Of Registration   with the
Maharashtra Medical Council, Mumbai
Application No :  MMC20240007467 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)  ROKADE PALLAVI RUPKUMAR
Registration No:  2019020375   Registration Date : 06/02/2019   Valid upto Date :06/02/2029
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 : Ms. ROKADE PALLAVI RUPKUMAR
Name of Father : Mr. ROKADE RUPKUMAR MURLIDHAR
Name of Mother : Mrs. ROKADE SUREKHA RUPKUMAR
In Case of Married Women
Maiden Name : -

RESEDENTIAL ADDRESS : D/O. RUPKUMAR ROKADE, G-29 TECHOPS CITY, GONHISIM LOTUS, BEHIND SANJUBA SCHOOL, HUDKESHWAR,
City : NAGPUR District : NAGPUR
State : MAHARASHTRA Country : INDIA
Pincode : 440034
Date of birth : 05/08/1994 Tel No (Res) : Clinic No :
Mobile No : 8087776412 Email Id : pallavirokade5@gmail.com  
Total Obtained Credits Points : 11
Remaining Credits Points : 19
Qualification Details
 Details of QualificationName of CollegeUniversityPassing YearCertificate NoCertificate Date
1.M.B.B.S.DPABD, AMRAVATIMAHARASHTRA UNIVERSITY OF HEALTH SCIENCES, NASHIK2018  
2.M.D.(Derm.Ven.& Leprosy)GOVERNMENT MEDICAL COLLEGE, NAGPURMAHARASHTRA UNIVERSITY OF HEALTH SCIENCES, NASHIK20224940/202228/09/2022
Pariticulars Of Payment
Payment Mode : Online Payment
Receipt No : IGAQWIBBO7
Receipt Date : 20/02/2024
   I have uploaded following documents:
1.Latest Passport size Photograph
2.Photocopy Of Additional Qualification certificate of MMC
3.Self attested photocopy of MMC Registration Certificate
4.Original Undertaking
5.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 : 16/02/2024
    Applicant signature               


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