APPLICATION FORM FOR REGISTRATION AS DENTIST
(Under the Dentists Act 1948)
PUNJAB DENTAL COUNCIL, S.A.S.NAGAR Recent
Medical Education Bhawan (3rd Floor), Sector-69, S.A.S.Nagar-160062 P.P.Size
Website: www.punjabdentalcouncil.com Photograph
Email: punjabdentalcouncil@gmail.com
Telephone No.0172-5197531
(To be filled in by the candidate)
To
The Registrar, Punjab Dental Council.
Sir,
I beg to apply for registration as Dentist under section 34(i), ii (a) and ii(b) of the Dentists
Act 1948. I request to enter my name, address & qualifications as stated below in Part A, of the
State Register of Dentists.
Registration No._____________________Valid upto 31.12.____________
(To be issued by the Council)
Name in full :
(In Block Letters only) ________________________________________________________________________
Date of Birth:________________Birth Place:____________________Nationality:______________________
Mobile No.:______________________________ E-mail Address :____________________________________
Father’s Name:_______________________________________________________________________________
Mother’s Name :______________________________________________________________________________
Residential Address:__________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Professional Address:_________________________________________________________________________
______________________________________________________________________________________________
PAN No.:________________________________Employment if any:__________________________________
Domicile Status (India/Foreign):______________________________________________________________
QUALIFICATIONS
Description of qualifications on which registration is desired BDS/MDS________________________
(only from recognized Dental College)
Name of the University or Faculty or Examining or Licensing body with full address
______________________________________________________________________________________________
______________________________________________________________________________________________
Institution through which appeared__________________________________________________________
______________________________________________________________________________________________
Date of attaining the qualification:____________________________________________________________
(i.e. Date of completion of paid Rotatory Internship Training)
I forward herewith in original the Provisional Degree/Degree/Diploma & all other required
documents for Registration as Dentist [with all the photocopies as required at Page 2 of this
Form]. The Original may please be returned, after perusal.
________________________
Dated:___________________________ Signature of the Candidate
Name in full………………….…………………………..
Regn. No…………………………. Valid Up to : 31.12._________
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Revised Dentists (Code of Ethics) Regulations 2014
Declaration - Every dentist who has been registered (either on Part A or Part B of the State Dentists
Register) shall, within a period of thirty days from the date of commencement of these regulations and
every dentists who gets himself registered after the commencement of these regulations shall, within a
period of thirty days from such registration, make, before the Registrar of the State Dental Council, a
declaration in the form set out for the purpose in the schedule to these regulations and shall agree to have
read, understood and thence to abide by the same.
FORM OF DECLARATION
(To be signed by the Dentist at the time of Applying for Registration under the Indian Dentists Act.1948)
(i) I solemnly pledge myself to devote my life to the cause of serving humanity in the field of dental
care;
(ii) I shall not use my dental knowledge contrary to the law of humanity;
(iii) I shall not permit consideration of religion, nationality, race caste and creed, party politics or social
standing to intervene in any duty towards my patient & the professions;
(iv) I shall look after the dental health of my patients as my first consideration;
(v) I shall honour the secrets, which are confided in me by my patients during the professional services;
(vi) I shall always maintain the honour & noble traditions of the dental profession;
(vii) I shall deem it an honour to cherish a proper pride in my colleagues and shall not disparage them by
my actions, deeds or words;
(viii) I shall not indulge in any activity, which might bring discredit to the dental profession;
(ix) I shall abide by the various provisions of the Act and desist from using a degree / diploma or an
abbreviation indicating or implying a dental qualification, which is not in accordance with the
definition of “recognized dental qualification” as defined under Clause (j) of section 2 of the Act;
(x) I shall strictly abide by the Revised Dentists (Code of Ethics), Regulations 2014.
Dated the___________________
_____________________
Place________________________ Signature
Name of Dentist_____________________________________
1. Documents required for Registration:-
Original & self-attested photocopies of the following documents:-
i Matric (Showing Date of Birth).
ii Detail Marks Certificate of 1st Prof., 2nd Prof., 3rd Prof & Final Prof of B.D.S.
iii Internship Completion Certificate (Only Paid Rotatory Internship Certificate).
iv Attempt Certificate and Character Certificate issued by the concerned Dental College.
v BDS Degree(or Provisional Pass Certificate issued by the concerned University or College)
vi Proof of Domicile/Residence of Punjab State /Aadhaar Card / Ration Card/Voter–I Card/ Driving
Licence/Passport/any other proof/Certificate issued by the concerned authority.
vii 2 Passport size photos.
Original testimonials will be returned after checking/comparison.
2. Fee:-
Registration fee : 1200
:
Fee can be paid in cash or through
Renewal fee 200 per year ( 1000 for 5 years)
:
Bank Draft favoring “Registrar
Misc.Office Exp. 500
Punjab Dental Council” Payable at
Smart Card : 500
Chandigarh
Maintenance Fund : 100
:
For out of state Regn. 1000
(Candidates passing B.D.S. Course from out-side Punjab State Dental Colleges will pay 1000 extra,
for verification of their Certificates, being "Out of State Registration", along with a Self
Declaration as per Specimen given at Page-4.
3. Late Fee:-
a) If a candidate is applying for his registration, after one year, from the date of his passing the B.D.S.
Course he / she will deposit 1500/- as “late-fee”, for the Ist. year and for subsequent years, he/ she
will pay late fee @ 2000/-per year AND a Self-Declaration given at Page 4
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b) If a candidate is applying for his registration, after one year, from the date of his passing the Dental
Mechanics / Dental Hygienists Course, he/she will pay 500/- as “late-fee”, for the Ist. year and for
subsequent years, he/she will pay late fee @ 800/- per year, along with a Self Declaration given at
Page-4.
c) The Dentists who have gone abroad without getting their registration, will apply on this form and
get it attested from the Notary Public / Solicitor of that country (below their signatures, along
with one P.P. size photo and all the documents mentioned at Page-2 duly attested). They will pay
$ 200 as fee. In case these candidates get their registration done after one year, from the date of
passing B.D.S. Course, they will pay $ 250 as “Late Fee” for 1st year and for subsequent years, he /
she will pay late fee @ $ 300 per year. They will also submit an affidavit duly attested by the
“Notary Public / Solicitor/ Any Attesting Authority of that country as per specimen given at Page-4.
d) Candidates already registered with any other State Dental Council in India, will have to produce
“No Objection Certificate” from that Council and from Dental Council of India, Delhi, for their
registration with the Punjab Dental Council, along with other documents (as mentioned at
Page No.2, Sr.No.1 (from i-vii) of this form).
e) As per instructions of the DCI, NRI students having OCI/PIO Card can apply for registration
(with proof of OCI/PIO) and all the documents mentioned at Page-2 (from Sr. No.1-7).
Registration fee for OCI/PIO Card holder is $100 and late fee @ $ 50 (per year).
4 Validity of N.O.C.
Regarding registration of Dentists by way of transfer from other state Dental Councils, the candidate
will produce “N.O.C.” from that state and from Dental Council of India (along with requirements
mentioned at Page-2 of this Form). Validity of that NOC will be considered for 6 months, from the
date of issue of NOC for his/her registration. Similarly validity of NOC issued by this Council will
also be six months from the date of issue of the NOC. Fee for issue of N.O.C. is 2000.
5 Issue of Duplicate Registration Certificate
For issue of Duplicate Registration Certificate, in case it is lost / misplaced, the applicant will
personally submit a Self Declaration or copy of D.D.R., along with one P.P. size photo and will
deposit a fee of 1000. For issue of duplicate Smart Card in case it is lost, fee of 500 will be
charged (with a Self Declaration or a copy of D.D.R.).
6. Any change in address, Mobile No. may please be intimated to this Office, immediately.
7 Time Schedule for issue of various certificates by the Council:-
i Time for issue of fresh/new Registration Certificate to B.D.S./ = 7 Working Days
M.D.S. / Dental Mechanics / Dental Hygienists by the Punjab
Dental Council.
ii Time for issue of Fresh Registration to B.D.S./ M.D.S./Dental = 2 Weeks
Mechanics / Dental Hygienists, who pass out from out of State
Dental Colleges.
(Because their D.M.C. / Degree is to be got verified from the
concerned Dental College / university as per instructions).
iii Renewal of registration = 3 Working Days
iv Issue of N.O.C. = 7 Days
v Issue of Good Standing Certificate / Duplicate Certificate and = 7 Days
other misc. services
vi Issuance of Smart Card = Same day
Subject to the Biometric /Online Computerized system is working
8 Important Note : -
A candidate will have to come personally for his/her registration.
Form & fee can be deposited in the office from 9:00 AM to 1:00 PM
and 2:00 PM to 3:00 PM on working days.
Please display your Registration Certificate at your clinic.
Do not laminate your Registration Certificate.
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[Page-4]
Self Declaration
I______________________________S/O,D/O___________________________
R/O_________________________________________________________________
_________________________, do hereby solemnly affirm and declare as under:-
i That I have passed my B.D.S. Course from___________________________
____________________________________________________________
(Name of Dental College),and was awarded Degree by__________________
__________________________________________________________
(Name of University) in the year __________, which is recognized by the
Dental Council of India and that I have completed my Compulsory Paid
Rotatory Internship from _____________ to ______________.
ii I undertake that in case any of my B.D.S./M.D.S. course Certificate is found
incorrect / false, I will be responsible for that and will surrender my Original
Registration Certificate to the Punjab Dental Council immediately and will
not practise Dentistry. In that event my Registration be deemed as cancelled.
iii I further certify that I am not yet registered with any other State Dental
Council in India, so far.
iv I certify that I was not involved in any court case or any legal proceedings
are pending against me professionally or otherwise.
_________________________
Signature of Declarant
Dated:_________________
