Membership Registration Form

DSK EDUCATION MEDICAL AND HEALTH CARE COUNCIL OF INDIA > Membership Registration Form

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Registration Application Form

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Date *

Registration Applied For : *

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Name of Candidate : *

Fathers / Husbands Name : *

Mothers Name : *

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Date of Birth *

Blood Gr : *

Nationality : *

Email *

Gender *

Aadhar Card No. : *

Contact No: *

Marrital Status : *

Pan Card No : *

Whatsapp Mob. No : *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Professional Address :

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

S. S. C.

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School Name

Board *

Month & Yr of Passing

Marks Obtained / Total Marks

H.S.C

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School Name *

Board *

Month & Yr of Passing *

Marks Obtained / Total Marks *

Diploma / Degree

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Diploma / Degree *

Name of College / Institute *

Board / University *

Month & Yr of Passing

Marks Obtained / Total Marks *

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Diploma / Degree *

Name of College / Institute *

Board / University *

Month & Yr of Passing

Marks Obtained / Total Marks *

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Diploma / Degree *

Name of College / Institute *

Board / University *

Month & Yr of Passing

Marks Obtained / Total Marks *

Experience : *

Practicing in : *

UPLOAD DOCUMENTS :

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Passport Size Photo JPG *

Click or drag a file to this area to upload.

S. S. C. / H. S. C Documents PDF *

Click or drag a file to this area to upload.

Signature JPG *

Click or drag a file to this area to upload.

Documents Diploma/Degree PDF *

Click or drag a file to this area to upload.

Dskemhccouncil C. M. E. Certificate PDF *

Click or drag a file to this area to upload.

Aadhar Card PDF *

Click or drag a file to this area to upload.

Documents Experience Certificate PDF *

Click or drag a file to this area to upload.

Are You Interested in taking a position in DSKEMHCCI.

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Your Country *

State *

District *

Choose a Position

DECLARATION :
* I hereby declared that all the information mentioned the above is true and correct to best of my knowledge & belief. I have read rules & regulations of DSKEMHCCI & I agreed to abide by it. I agree for my membership registration of our DSKEMHCCI.
* I will do business according to the rules just like the science in which i have studied. I have to follow the Rules and Regulations prescribed from time to time as per Supreme Court,Government Law.
* If anyhow any information or above statement is proved false, my membership will be cancelled instantly and fees paid for that purpose will be forfeited automatically. All rules & regulations of DSKEMHC Council of india will be binding on me.
* I shall hereby give undertaking that i shall abide by rules and regulations of council membership, failing which my membership will be stood cancelled.

Accepted Terms & Conditions *

Accept

* Note :- Please enclose self attested Xerox Copies of your qualification. ( Diploma /Degree Certificate,Marksheet,Registration, Experience Certificate, Dskemhc Council C.M.E. Certificate, S.S.C., H.S.C. Marksheet, L.C., Aadhar Card, Passport size photo )