APPLICATION FOR RESTORATION OF NAME IN THE REGISTER Arunachal Pradesh Medical Council (See Rule 29 (6)) FORM- 7 Receipt No Date (for office use only) To, The Registrar, Affix passport size photograph attested Arunachal Pradesh Medical Council, Naharlagun. Sub:- Restoration of name in the Register. Sir, 1. I, the undersigned (full name and address)holding qualification of do solemnly declare that the following are * facts of my case on which I seek restoration of my name in the Register. 2 My name was duly registered in the State Register of having registration number (Name of the State) dated 3. My name was duly registered in the State Register of Arunachal Pradesh Medical Council on having registration number Board/ 4. At an enquiry held on the by the Council/ Committee of my name was directed to be removed from Board/ the State Register and the offence(s) for which the Council/ Committee of directed removal of my name was/were Published on National Portal of India (india.gov.in) 5 Since the removal of my name from the Register. I have been residing at and my occupation has been 6. It is my request that my name be restored in the Register of State The grounds for the present application are: 7. (i) (ii) (iii) 8. The prescribed fee of Rs.1000/- (Rupees one thousand) deposited by Bank Draft No dated in favour of Arunachal Pradesh Medical Council payable at Naharlagun. I request that orders may be passed for restoration of my name in the State Register of 9. (State) 10. I submit three recent passport size photographs. 11. I submit Arunachal Pradesh Medical Council Registration Certificate in original. Declared at Before Signature (for office use only) Received the above documents in original Signature of registered person Name Date Published on National Portal of India (india.gov.in)
