Application for Renewal Of Registration   with the
Maharashtra Medical Council, Mumbai
Application No :  MMC20240015462 Date : 31/03/2024
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)  KUKADE KIRTIKA PURUSHOTTAM
Registration No:  2019030677   Registration Date : 01/03/2019   Valid upto Date :01/03/2029
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. KUKADE KIRTIKA PURUSHOTTAM
Name of Father : Mr.
Name of Mother : Mrs.
In Case of Married Women
Maiden Name : -

RESEDENTIAL ADDRESS : SARASWATI NAGAR, TUKARAM CHOWK, GAURAKSHAN ROAD, TAL-DIST-AKOLA-444001
City : AKOLA District : AKOLA
State : MAHARASHTRA Country : INDIA
Pincode : 444001
Date of birth : 03/12/1993 Tel No (Res) : Clinic No :
Mobile No : 8554959280 Email Id : kpkkirtika@gmail.com  
Total Obtained Credits Points : 47
Remaining Credits Points : 0
Qualification Details
 Details of QualificationName of CollegeUniversityPassing YearCertificate NoCertificate Date
1.M.B.B.S.INDIRA GANDHI MEDICAL COLLEGE & HOSPITAL, NAGPURMAHARASHTRA UNIVERSITY OF HEALTH SCIENCES, NASHIK2018  
2.M.S.(Obst. & Gynae.)SHRI V.N.MEDICAL COLLEGE,YAVATMALMAHARASHTRA UNIVERSITY OF HEALTH SCIENCES, NASHIK20224291/202311/10/2023
Pariticulars Of Payment
Payment Mode : Online Payment
Receipt No : 0819407453
Receipt Date : 02/04/2024
   I have uploaded following documents:
1.Latest Passport size Photograph
2.Self attested photocopy of MMC Registration Certificate
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 : 31/03/2024
    Applicant signature               


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