FTP Registration - Apply for Temporary Permission

Apply for Temporary Permission, U/S 34, NMC Act

I. Personal details

1. Name of Professional (IN BLOCK LETTERS):*

2. Mother/Father's Name (IN BLOCK LETTERS):*

3. Date of Birth:*

4. Gender:*

5. Present Address:*

6. Permanent Address:*

7. Email Address:*

8. (i) Mobile No. / (ii) Alternate Mobile No.:*

Payment Amount (Includes 18% GST) Rs : 5,900.00

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