INSTRUCTIONS

1) The applicant should come in person to the office.

2) All particulars of the application must be filled by the applicant only in neat legible
hand

3) The name and particulars entered in this application form must be exactly correspond
with the name and particulars of the applicant entered at the University or other
examination.

4) Xerox taken from scanned certificates are not accepted, take colour Xerox (A4 size)
directly from the original certificates.

5) Payment through Q R Code Scan pay only accepted. Cheque / Cash / Demand Draft
/ Direct Deposit Payment to our office Account / Direct Cheque Payment to our office
Account & Fund Transfer are not accepted.

Documents to be submitted along with the

M D S Degree Application Form

A) All Original Certificates & Address proof take (A4 Size) colour copy. It’s Mandatory.

1 Take a (A4 size) colour printout of the application form.

2 Original Tamil Nadu Dental Council BDS Registration Certificate has to be

surrender herewith for Cancellation.

3 MDS Provisional Certificate (issued by the University).

4 MDS Course Completion Certificate (issue by the Dental College).

5 MDS Transfer Certificate (issued by the Dental College).

6 MDS Mark List (issued by the University).

7 *Fee : Rs.1100/- Online Payment only accepted.(Details given below)

8. Two Recent Indian Passport Size Photo’s (Size – 4.5 cm X 3.5 cm) (Photograph
taken from Studio only accepted with clear image of face with high
resolution)

9. Aadhaar Card is must. 2nd option is Voter id & Valid Indian Passport are only
accepted. Any one of the proof taken in a A4 sixe colour Xerox, both pages
taken in a single side must be submitted.
 TAMIL NADU DENTAL COUNCIL
Arihant Majestic Towers, Flat No.5-0-3, No.216, J N Salai, Koyambedu Chennai – 600 107.

FORM OF APPLICATION FOR REGISTRATION OF M.D.S. DEGREE

(FILL UP THE BELOW ALL DETAILS IN CAPITAL LETTERS. IT’S MANDATORY)

To
The Registrar
Tamil Nadu Dental Council Affix Here
CHENNAI – 600 107. Recent
Passport
Sir, Size
I request to register my M.D.S. degree in the council, for Photo
which all required particulars are furnished below.

1) Applicant Name :

2) Father’s Name :

3) Mother’s Name :

4) Date of Birth :

5) Birth Place :

6) Gender : MALE / FEMALE

7) Nationality :

8) PAN Number :

9) TNDC Registration No. :

10) BDS Date of Registration :

11) Domicile Status : INDIA / FOREIGN

12) Category : OC/FC/BC/MBC/SC/ST/PHD/OTHERS-

13) Permanent Residential Address:-

Building/House Name :
Door No./Flat No./Plot No. :
Street/Road :
Area/Place :
Village/Panchayat :
Post :
Taluk :
City :
Pincode :
District :

-2-
 (2)

14) Mobile No. :

a) Landline No. :

b) E-Mail ID (Fill in Capital letters*) :

c) Aadhaar Number : / /

15) Qualification : MASTER OF DENTAL SURGERY

16) Month & year of the final :

Examination held in
17) Name of the M D S Branch :
18) Name of the college :
19) Name of the University :
20) Online Payment Details:
UPI/UTR Tran No. (&) Date :
Bank Name (&) Branch :

I hereby declare that I have read carefully and understood the instructions and that
all entries made in this application are true to the best of my knowledge and belief.

I agreed to abide by the ethical rules for dentists which may be laid down for the
guidance of the registered dentists from time to time.

Yours faithfully,

Date : (Signature of the applicant)

INSTRUCTIONS
1) The applicant should come in person to the office.
2) The name and particulars entered in this application form must be exactly
correspond with the name and particulars of the applicant entered at the
University or other examination.

Note :- All original certificates will be verified and returned to the applicant .

(Received all my Original Certificates & MDS Registration Certificate)

Applicant Signature:...................…………………………………………….

Applicant Name:..............……………………………………………………….

Mobile No.:..………………………………………………………………………...

Date:.....………………………………………………………………………………