PM&DC-FORM-l (Denial) REOUEST FOR PROVISIONAL REGISTRATION ON THE REGISTER

DENTAL PRACTITIONERS (Pari-B) FOR HOUSE JOB ONLY

OF

Website:

TEL: 051-9106151-54 www.pmdc.org.pk

Fax NO.051-9106159 E-mail: pmdc@pmdc.org.pk

APPENDIX-2

These forms can be downlooded from our website by using Acrobat Reader. Pootocopy of this fonn is also acceptable

PMDC Re istration No
(For office use only) Please paste one Photograph

To, The Registrar Pakistan Medical & Dental Council G-I 0-14, Mauve Area, Islamabad.

By hand

Courier

,-------J
_ _ _ _

(Please read and undersland the instructions belore filling this form) Dear Sir, I have qualified BDS final exam held on .trom. l may be provisionally registered on part-B of the register of Dental Practitioners (under the PM&DC Ordinance, 1962) and a PM&DC certificate of provisional registration may be issued so that I can start my house job training. completion of which is a prerequisite for full registration. My particulars are as under: (All columns are to be filled in block leUers): 1. 2. 3. Name Father's Namc. PrescnVMailing Address Pemlanent Address PM&DC students registration No. C.N.I.C.(NADRA) No. Cell ph No. Bank DraftJPay Order ofRs. Name of issuing branch Nationality Province of domicile Gc.nder-MIF Date ofBirth E.mail(essential) Daled

4.

5. 6. 7.

_ _ _ _ _

.No.
(Name of Doctor must be wrilten on [he backside of bank draft)

'Cash can be deposited at the Bank counter in the PM&DC office Islamabad. 8. Particularsof 8DS or equivalent basic qualification requiredto be registered Name of University Name of Dental College Date of admission in 1st Year BDS Class Age on the dale of admission Y-M--D Dale of final Examination Held Date of result Declared

Name of ,. Qualification

ADDITIONAL INFORMATION REQUIRED DDS NAME OF MEDICAL YEAR COLLEGE I" YEAR BDS 2'~YEAR BDS 3"YEAR BDS 4m YEAR BDS

ATTENDED FORM

NAME OF UNIVERSITY TO

PMDC FORM.I (DENTAL) PAKISTAN MEDICAL & DENTAL COUNCIL MAUVE AREA G.IO/4 ISLAMABAD. TEL: 051-9106151-54 Fax NO.051-9106159 \Vebsite: www.pmdc.org.pk E-mail: prndcsec@isb.paknetcom.pkpmdc@pmdc.org.pk
(Please read these important INSTRUCTIONS carefully and visit our web site (www.pmdc.org.pk )

1.

GENERAL
(i) 0) The applicant must fill in PM&DC form-) in hi~ own neat and legible handwriting or it may be typed. The applicant doctor must sign the Form himself. Incomplete & illegible forms will not be considered. Registration certificates will be dispatched to the applicant by post within one month from the date of receipt of application provided all required formalities are complete. In case there is any objection the process can be delayed. If ca~ hao; been submitted by hand plea quote receipt no in any inquiry about the case. Request for ftrst time registration shall not be e entertained on urgent basis. The applicant doctor shall collect the Registration Certificate personally, Incase applicant is sending a collector. he must have an authority letter attesting his signatures, Such persons shookl provide photocopy of their national identity card. for record of this office and must be in pos..o:;csstonf the original bank receipt. o The provio:;ionalregistration will only be extended once,

(iii)

(iv)

CONVERSIONOFPROVlSIONAL REGISTRATIONINTOFULL REGITRATION

On completion of ont"-year P~I&DC prescribed house job from a PJ\:IDC appro'H.'d ho~;pital a doctor may apply for full Registration by submitting the following mandatory documents. The original Pl\l&DC provisional registration certificate, Three recent pas.o:;p~rtsize photogrnphs, Photocopy or house job (one year) certificates attested b)' the respective 1\1S qualif)'ing the structured housejob examination conducted b)' a PM&DC apprm:ed entity Photocop)' or~lBBS degrt't' atk'~1ed b)' the respective Prindpal. Fee Rs.1500/.

2.

FEE SCHEDULE
Regi.<;trationof name on the medical register Part B (provi.<;ional)of the basic dental qualification for five years Within six months of graduation; Rs. 500/= After a lapse of six months: RS.lOOO/= After one year; RS.I2S0/= For each change in registration certificate Rs. 1000/= If certificate is required to be delivered by couriers with in Pakistan, Rs.lOO/. out side Pakistan, DIlL rates Foreign nationals pas.o;;ing BDS from Pakistani Universities Rs. 1000/= for one year Extension of provisional registration Rs.ISOO/= l"'dm )'ear Fee for verification of registrationlgoodst.-ulding overseas as.lOOO/=

Ca,o;;han be deposited allhe Bank counter in the PM&DC office l<;lamabad. c Foreign Nationals and Pakistani doctors applying from foreign countries should pay equivalent amount in foreign exchange through Bank DraftICashier's Cheque of a recognized bank payable in Pakistan in favour of bank account titled "PAKISTAN MEDICAL & DEl\'TAL COUNCIL" (withoot mentioning account number). f'Or further details to submit fee while being abroad kindly visit our website 3, After five ye<m the name of the doctor will only be retained on the medical register on payment of prescribed fee for retention of name,

4.
5. 6.

IN CASE OF LOSS/MISI'LACEMENT OF REGISTRATION CERTWICATE

please use PM&DC form 8

In case change of name after marriage is required. please send auested photocopy of Nikaah Nama OR Affidavit (specimen is given below) along with a fee ofRs 1000/= to amend the certificate, any false infonnation given herein Sh~lllmake the applicant liable for cancellation of PM&DC registration

SPECIMEN OF AFFIDAVIT ON STAMP PAPER OF RS.IO/FOR THE CHANGE OF NAME AFfER MARRIAGE AI'FIDA vrr
I, Dr. ____________________ Daughter of Now residing at Pennunenl address _ _ & Dental Council as my married name as be issued registration and nothing has been

Do hereby solemnly affirm and declare on oath that before my marriage I was registered with the Pakistan Medical (Name) , Now I am married to und I have adopted Dr, . (Documentary proof anached i,e Nikah Nama/Govt notification) Therefore, I may certificate in my married name as given above. The above statement is correct to the best of my knowledge and belief concealed or suppressed by name in this behalf.

Signature and SE"'"dl

or the court

Depont.'nt

II

Documents 10 be attached: Duly aUested photocopy (with blue ink) by the Principal of respective coUege: Provisional BDS cemficateldegree/professional examination certification. FSc (pre-medical certificate/equivalence certificate from lBCC Islamabad. Student registration certificate issued by PM&DC. Migration cases to provide all related documents Three photographs (passport size) one anested on front side on the form and others on the back with white background and both cars are visible. Photostat copy of Computerized National I.D.Card issued by NADRA.

12. Undertaking: I undertake to abide by the Code of Ethics prescribed by the PM&DC for registered MedicaVdental practitioner and will inform the Registrar, Pakistan Medical and Dental Council of any change of address of residence or practice with in thirty days. I have never been registered with PM&DC in the past If considered necessary. PM&DC may disclose any information when asked for or obtain any
information from any of my educational instilution and I IibcrJte PM&DC and the institution for ,my liability for this action. I further Underti.lke that if there has been an erroneous entry in the certificate and I am told by the PM&DC 10 send the certificate back to PM&DC I !JlaJl do so immediately and shall not take any benefil of the error, Above information i'i correct and nothing has been concealed and if found false or oontrJI)' to PM&DC rules. I am liable for necessary action by the Council which may lead to c.mcclIation of registration. ftake full responsibility ofaulhenticity of documents submitted along with application

Full Nwne Dr ..

Signature.

Ceurrel No:

EmaiI: (fOR USE Of' TilE OFFICE OF THE PRINCIPAL

Date. ONLY) held on _

Dr.
___________________________

has passed

final BDS exam

from

.HislHer application is verified and recommended for

provisional registf'dtion as Dental pmctitioner for house job. The required documents duly attested by the undersigned are enclosed.

Principal (Signature & Stamp) (FOR Pl\I&DC OFFICE USE ONLY) Received Rs. Dr.. __________ (Rupces _ ) vide receipt No. _dated

is provisionally registered with PM&DC as Dental prdclitioner on this day

for a period of one year for house job only.

Assistant

Superintendent

AssttlDeputy Registrar