Application for
Renewal Of Registration
with the
Maharashtra Medical Council, Mumbai
Application No :
MMC20240010343
Date :
05/03/2024
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)
RANE CHAITANYA DILIP
Registration No:
2019043244
Registration Date :
27/04/2019
Valid upto Date :
27/04/2029
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.
RANE
CHAITANYA
DILIP
Name of Father
:
Mr.
Name of Mother
:
Mrs.
In Case of Married Women
Maiden Name
:
-
RESEDENTIAL ADDRESS
:
A-13, GIRNAR HILLS, SHIVAJI NAGAR, NEAR DATTA TEMPLE, KUDAL, SINDHUDURG
City
:
KUDAL
District
:
SINDHUDURG
State
:
MAHARASHTRA
Country
:
INDIA
Pincode
:
416520
Date of birth
:
11/07/1995
Tel No (Res)
:
Clinic No
:
Mobile No
:
9619618358
Email Id
:
chibud1@gmail.com
Total Obtained Credits Points
:
36
Remaining Credits Points
:
0
Qualification Details
Details of Qualification
Name of College
University
Passing Year
Certificate No
Certificate Date
1.
M.B.B.S.
LTMC MUMBAI
MAHARASHTRA UNIVERSITY OF HEALTH SCIENCES, NASHIK
2019
2.
M.D.(Radio Diagnosis)
GSMC MUMBAI
MAHARASHTRA UNIVERSITY OF HEALTH SCIENCES, NASHIK
2022
3159/2022
04/08/2022
Pariticulars Of Payment
Payment Mode
:
Online Payment
Receipt No
:
202406864834120
Receipt Date
:
11/03/2024
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.
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 :
05/03/2024
Applicant signature
NOTE:- You do not need to submit the print out of original submitted Renewal Application form to MMC office.