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ANDHRA PRADESH MEDICAL COUNCIL

SULTAN BAZAR :: HYDERABAD

Application for Renewal of Medical Registration See Section-15C of A.P Medical Practitioners Registration (Amendment) Act, 2013
To The Registrar, A.P.Medical Council, Hyderabad-500095. Affix recent Passport size Photograph duly attested by any Civil Surgeon / Prl.of anyMedical College/Supdt. of any Hospital

Sir, I, undersigned Dr.___________________________________ registered with A.P.Medical Council under Registration No_______________ dated_________ . I have complied with the requirements of Section-15C of A.P.Medical Practitioners Registration Act, 1968 (Amendment Act No.10 of 2013) and the rules made thereunder. Necessary Fee is paid herewith in the shape of Demand Draft drawn in favour of Andhra Pradesh Medical

Council, and request that my Medical Registration may be renewed and a certificate be
issued. The details are as under. NAME OF THE DOCTOR:_________________________________________________ (With Surname in full and in block letters) FATHERS NAME MOTHERS NAME BLOOD GROUP DATE OF BIRTH REGN. NO.& DATE :__________________________________________________ :__________________________________________________ :__________________________________________________ :___________________________SEX:___________________ :__________________________________________________

QUALIFICATION / COLLEGE & UNIVERSITY:_________________________________________________ PERMANENT ADDRESS :__________________________________________________ ______________________________________________ E-mail______________________ Pin code No: _____________Phone No. _____________
Medical Qualifications for which Registration was granted Name of the Medical College / University where the Degree was obtained Details of Registration No. and Date

P.T.O

:: 2 :: The originals and the attested copies of the required documents are submitted herewith. The originals may kindly be returned when no longer required. The above facts are true to the best of my knowledge. Yours faithfully,

( Signature of the Doctor)

REQUIREMENTS FOR RENEWAL OF MEDICAL REGISTRATION: 1. D.D. For Rs.1000/- drawn in favour of ANDHRA PRADESH MEDICAL COUNCIL , HYDERABAD from ANDHRA BANK. 2. Final Medical Registration Certificate issued by A.P.Medical Council in original and its copy and certificates of Registration of Additional Qualifications if any. 3. Proof of Date of Birth (SSC, Passport or any relevant certificate). 4. One Recent Passport size photograph. 5. Attendance Certificates of C.M.E programmes having not less than30 credit hours during the preceding five years. 6. Late Fee of Rs. 100/- per month after 09-09-2014 for a further period of one year.

D.D.No...,Date.,Rs.. Bank Name:....Branch Name.,Branch Code.

REGISTRAR Note:i). ii). iii). Every Registered Medical Practitioner shall renew his Registration after expiry of the period of five years from the date of his original Registration. Renewal of Registration shall be done before 09-09-2014. The Registered Medical Practitioner who fails to renew his registration within the stipulated period, can renew his registration upto a further period of one year on payment of late fee. No application for grant of renewal of Registration will be accepted on or after the date specified in this regard even on payment of late fee. The name of the Registered Medical Practitioner will be removed from the Register, if he fails to renew his Registration as specified above. Fresh Registration will be granted in case of the removal of names of Registered Medical Practitioners from the Medical Register as per the procedure laid down in Rules.

iv).

v).

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