FORM FOR RENEWAL OF REGISTRATION (To be filled in by the Applicant) 1. Name of the Doctor & ________________________________________________ Registration No. 2. Father's Name ________________________________________________ 3. Registration / Renewal ________________________________________________ Valid Up to 4. Qualifications (Name of College/Univ. with year of passing B.D.S/ M.D.S 5. (i) Permanent Address (ii) Correspondence Address with Tel.No. & E-Mail (iii) Professional Address 6. Name & Full address of two 1. _____________________________________________ eminent Persons, who personally know the Applicant and to whom a reference can be Made, (One should be a Dental Surgeon, 2. _____________________________________________ Registered with Punjab Dental Council, Write his Registration No. 7. Reasons for not getting renewal Up-date in time (wherever applicable) Dated: _______________ Signature of the applicant Note: 1. The applicant will come personally for renewal of his/her registration along with original Registration Certificate or an attested photocopy of the registration Certificate and one P.P size photo duly attested. 2. In case he / she cannot come personally, he/ she will submit his/ her Form and photo for renewal, duly attested by any Member of the Public Dental Council, with renewal fee, by post or through someone. 3. The Dentists applying from foreign countries will get their renewal Form attested from the Notary of that country (below their signatures), alongwith one P.P size photo duly attested.
