APPLICATION FORM FOR OBTAINING A CERTIFICATE OF "GOOD STANDING" FROM PUNJAB DENTAL COUNCIL: 1. Name of the Doctor & Registration No. & Date of Registration 2. Father's Name 3. i) Present Address ii) Permanent Address 4. Qualification (Name of university, with year) 5. Name of the institution from where the applicant has passed his/her B.D.S/M.D.S., with year. 6. Places at which he/she had worked during the last five year, with full details (Please use separate sheet if space is not sufficient). 7. Name & full address of two eminent persons, who personally know the applicant and to whom a reference can be made, (one should be a dental surgeon, registered with Punjab Dental council). Dated : Signature of the applicant (Please attach attested photo copy of the Registration Certificate and one P.P. Size photo duly attested.) INSTRUCTIONS TO CANDIDATES FOR FILLING UP THE APPLICATION FORM FOR OBTAINING "CERTIFICATE OF GOOD STANDING" The application form should be properly and neatly filled in. 2. Fee of Rs.1000/- (Rs. One thousand only) should be deposited in the office of Punjab Dental Council. 3. Please attach attested photocopies of the Registration Certificate and one P.P Size Photo duly attested. 4. Candidates Studying abroad will get this form attested from the Notary Public of that Country (below their signatures) alongwith one P.P size photo and a copy of Registration Certificate.
