WEST BENGAL MEDICAL COUNCIL

IB-196, Sector-III, Salt Lake City, Kolkata – 700 106

2335-3078 / 5575 / 5663, Email : wbmc@wbmc.in
W ebsite : www.wbmc.in

PROFORMA FOR UPDATING OF REGISTRATION

(To be filled in block letters)
1. Name
…………………………………………………………………………………………………………….
(Surname) (Middle Name) (First Name)
2. Father’s Name : Mr. / Dr. / Late ……………………………………………………………………

3. Date of Birth : ……………………… 4. Sex : M F (Please put √ mark)

5. Blood Group : ………………………

6. (A) Address : (i) Permanent …………………………………………………………………………..

P.O. …………………………… District ……………………… Pin Code

State …………………………… Country ……………………..

(ii) Present …………………………………………………………………………….

P.O. …………………………… District ……………………… Pin Code

State …………………………… Country ……………………..

(iii) Address where the applicant desire to get the Updated Registration Certificate by Speed Post
( Please put √ mark ) [Permanent Address / Present Address]

7. (B) Applicant’s Chamber / Hospital Residence Mobile

Phone Nos.

8. Email : …………………………………………………………………………………………….

9. Registration (a) No. ………………………………. (b) Date …………………………….

10. Details of Medical Qualification (s) :

Qualification and Name of the Name of the University / Institution
qualifying year* Medical College / School conferred Degree / Diploma

* Please refer to the Original Registration Certificate issued by the Council.

11. Details of payment : ( Please put √ mark )

(i) Bank Draft No ……………… dated ………………… on ………………………… ( Name of
the Bank ) for Rs. 1050.00
12. Signature of the applicant in full against A and specimen against B

Affix recent
passport size color
photograph of the A.
………………………………………………………………………………………………
applicant
( The photograph B.
should not be
signed
or attested )
Do not sign outside the boxes and in block letters

13. Certification by another Medical Practitioner registered with the West Bengal Medical Council.
Certified that the above particulars, photograph and signature are true.

__________________________________________
Signature with date and Registration Number
 HOW TO SUBMIT APPLICATION FOR UPDATING

The medical practitioners can obtain Proforma Application for Updating (2014-15) from the
off ice of the West Bengal Medical Council f ree of cost or can dow nload the same f rom our
website [www.wbmc.in] and print the same in a Legal size paper.

The Proforma duly filled in (without leaving any column blank), signed and countersigned to be
submitted affixing a recent passport size colored photograph together with Service Charge
of Rs. 1 050/- (Rupees One Thousand Fifty) only [through duly receipted Challan in case of Online
/ Offline payment or Bank Draft] in the office of the Council at the drop box during normal
office hours or be sent by post / courier on and from 18 th August, 2014.

HOW TO DEPOSIT SERVICE CHARGE

Payment by Demand Draft - The medical practitioners can also deposit Service Charge
directly to the office of Council through Bank Draft drawn in favour of "West Bengal medical
Council" payable at Kolkata. The filled up Application Form along with Demand Draft may he
submitted to the Council Office either personally /messenger or by post.

Payment by Cash would also be accepted by the Council in its office for such updating
purpose.

FOR RECORDING ADDITIONAL QUALIFICATION AND / OR CHANGE OF SURNAME

( IN CASE OF FEMALE DOCTORS ONLY ) WITH THIS APPLICATION FOR UPDATING

1) The medical practitioners who have already registered their Change of Surname ( in case of
female doctors only ) / additional qualification(s) with the Council need not to apply again but
they w o u l d o n l y a p p l y f o r u p d a t i n g m e n t i o n i n g t h e i r a d d i t i o n a l q u a l i f i c a t i o n ( s ) / c h a n g e d
s u r n a me already registered with the Council.

2) The medical practitioners who have not yet registered their additional qualification(s) /
Change of Surname ( in case of female doctors only ) with the Council, the incumbent is first
required to ma k e se p a ra t e a p p l ic a ti o n fo r r e g i s t r a t i o n o f a d d it i o n a l ( p la n f ic a t i o n (s ) / C h a n g e o f
S u r n a me ( i n c a s e o f f e m a l e d o c t o r s o n l y ) w h i c h c a n b e h a d f r o m t h e o f f i c e o f t h e C o u n c i l f r e e
o f c o s t o r downloaded from our website along with prescribed fees* and supporting documents. The
details of p re sc ribe d fe e s an d su pp o rtin g doc u me n ts ca n be h ad fro m th e Ap p lica tion Fo rm fo r
Additional Qualification / Change of Surname. Payment of fees for recording Addition qualification /
Change of Surname c an n o t n o t b e ma d e th ro u g h o n lin e o r o ffl in e mo d e o r b y D e ma n d D ra ft, a s
sta te d a b o ve . The dep osit o f app lica tion fees a re to be made in the offic e of th e Coun cil on ly
(Time - Mond a y to Friday up to 2.30 PM). Then he/she will make Application for updating
either through online payment or offline payment or by Bank Draft as stated above.

* Prescribed Fees [ existing ] - may vary from time to time.

Rs. 2000.00 for each Post Graduate Diploma Qualification.

Rs. 3000.00 for each Post Graduate Degree Qualification.

Rs. 4000.00 for each Post Doctotal Qualification.

Rs. 1000.00 for Change of Surname.

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V i si t us at www.wb mc.i n