Application for Renewal Of Registration   with the
Maharashtra Medical Council, Mumbai
Application No :  MMC20240021284 Date : 23/04/2024
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)  PATIL NILESH KHANDERAO
Registration No:  2019053568   Registration Date : 04/05/2019   Valid upto Date :04/05/2029
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. PATIL NILESH KHANDERAO
Name of Father : Mr. PATIL KHANDERAO TUKARAM
Name of Mother : Mrs. PATIL VANDANA KHANDERAO
In Case of Married Women
Maiden Name : -

RESEDENTIAL ADDRESS : FLAT201, SURYADARSHAN APT, NEW PANDIT COLONY, SHARANPUR ROAD, DIST- NASHIK
City : NASHIK District : NASHIK
State : MAHARASHTRA Country : INDIA
Pincode : 422001
Date of birth : 10/07/1995 Tel No (Res) : Clinic No :
Mobile No : 8668494316 Email Id : nilesh192133@gmail.com  
Total Obtained Credits Points : 0
Remaining Credits Points : 0
Qualification Details
 Details of QualificationName of CollegeUniversityPassing YearCertificate NoCertificate Date
1.M.B.B.S.MVPSVP MED NASHIKMAHARASHTRA UNIVERSITY OF HEALTH SCIENCES, NASHIK2019  
2.M.D.(General Medicine)SMBT INSTITUTE OF MEDICAL SCIENCES & RESEARCH CENTRE, NANDIHILLS, NASHIKMAHARASHTRA UNIVERSITY OF HEALTH SCIENCES, NASHIK20233732/202318/09/2023
Pariticulars Of Payment
Payment Mode : Online Payment
Receipt No : 2229719
Receipt Date : 24/04/2024
   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
5.Proof Of Exemption
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 : 23/04/2024
    Applicant signature               


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