Science

PM&DC–FORM-II RETENTION OF NAME ON THE REGISTER OF MEDICAL/DENTAL PRACTITIONERS
TEL: UAN 111-321-786 , 9266004 Fax No.051-9266427 Website: www.pmdc.org.pk E-mail: pmdc@pmdc.org.pk
These forms can be dow nloaded from our website by using Acrobat Reader. Photocopy of this form is also acceptable

PMDC Registration No — The Registrar Pakistan Medical & Dental Council G-10-/4, Mauve Area, Islamabad. Sir,
Please paste one Photograph

It is requested that my name may please b e retained on the register of the council for a further period of five years. I am enclosing the following documents: 1. Original PM&DC Registration Certificate. 2. Copy of MBBS/BDS degree/postgraduate degree/diploma attested by the respective Principal or his authorized Professor. (mandatory requirement if not submitted earlier) 3. Three recent photographs (2 Passport size and one identity Card size) 4. Copy of National I.D Card.

Fee deposited (in Rupees)
Fee for retention of name in medical register Late fee Urgent fee Courier charges Change in certificate Total fee

A bank draft/pay order of Rs._______________ No._____________________________Dated_________________ Name of issuing branch______________________________________________________

___________________
(Name & Registration No. of Doctor must be written on the back side of bank draft)

Cash can be deposited at the counter in the PM&DC office Islamabad.

(Fill in with block letters)
Name with Father’s Name Date of Birth Qualifications already registered Permanent Address Present Mailing Address

City/Dist Phone

City/Dist Phone

Present place of practice/posting (complete address with designation) ___________________________________

Note: For registration/recognition of additional postgraduate qualification use PM&DC form No.6 & 7. In case of any deficiency in documents/fee the case will not be processed further.
Undertaking:
I undertake to abide by the Code of medical Ethics prescribed by the PM&DC for...