ANDHRA PRADESH MEDICAL COUNCIL
AFFIX
{A.P. Medical Practitioners Registration (Amendment) Act, 1968}
RECENT PASSPORT
SIZE PHOTOGRAPH
To
The Registrar,
A.P. Medical Council,
DULY ATTESTED *
2nd Floor, Dr.Y.S.R UHS,
Vijayawada - 520 008, A.P
Tel: 0866-2455280, 2455281
Email Id: contact@apmedicalcouncil.in
Website: apmc.ap.gov.in
FORM OF APPLICATION FOR
(Tick whichever applicable) (Specimen Signature of the Applicant)
1. Final Registration (IMG) 9. Renewal of Registration (1st Renewal)
2. Final Registration (FMG) 10. Renewal of Registration (2nd Renewal)
3. Final Registration (Duplicate) 11. Re-Registration
4. Provisional Registration (IMG) 12. Renewal of Registration (Duplicate)
5. Provisional Registration (FMG) 13. NOC (IMG) State
6. Provisional Registration (Duplicate) 14. NOC (FMG) State
7. Additional Qualification Registration (PG) 15. APMC Good Standing Certificate (IMG)
8. Additional Qualification Regn. (Duplicate) 16. APMC Good Standing Certificate (FMG)
Name (in capital letters) :
(Full Name should be written with Surname
As per the MBBS Degree)
Registration Number: Date of Registration:
Father’s Name: Mother’s Name:
Date of Birth:
Gender (M/F):
(DD/MM/YYYY)
Nationality: Aadhaar No:
Mobile: Email:
Passport Number: Blood Group:
Permanent Address (in capital letters):
Pin code:
QUALIFICATION DETAILS:
Qualifications Name of the College / University Year of Examination
1.
2.
3.
Mode of Payment: Swiping of Debit / Credit Card at the APMC Counter.
# IMG – Indian Medical Graduate # FMG – Foreign Medical Graduate
Yours faithfully,
(Signature of the Applicant)
ATTESTATION OF PHOTOGRAPH
For Provisional / Final Registration Certificate to AP Candidates, attestation by the
concerned Principal of the Medical College is mandatory.
For Provisional / Final Registration Certificate to Other State candidates, attestation
by the concerned Principal of College / Supdt. of the Medical College Hospital is
mandatory.
For Provisional / Final Registration Certificate to Foreign Medical Graduates, the
attestation by any Professor of a Medical College is mandatory.
Important Note:
Please verify: -
• Annexure-I: Checklists of the Fee details and the Documents to be enclosed to
the Application Form.
• Annexure-II: Late fee Structure.
• Annexure-III: Check list of the Documents to be enclosed to the Application Form
for Foreign Medical Graduates.
• Annexure-IV: Proformas of Affidavits – [A] to [F] / Declaration Forms (to be
submitted on Non-Judicial Stamp Paper duly attested by a Notary Public).
• Annexure-V: Code of Medical Ethics Declaration.
• Annexure-VI: Details of Visa entries in the Passport - for Foreign Medical
Graduates.
• Annexure-VII: Identification Certificate - Proforma.
No application will be considered without these documents.
TATKAL: ON PAYMENT OF AN EXTRA FEE OF Rs. 2000/- FOR EACH CERTIFICATE.
SLOT BOOKING IS MANDATORY BEFORE VISITING AP MEDICAL COUNCIL
(Slot booking facility available in the APMC Website)
2
DECLARATION OF THE APPLICANT
I certify that no disciplinary proceedings under
the Andhra Pradesh Medical Practitioners
Registration Act, 1968 are in progress against me
and I have never been the subject of any inquiry. I
have not ever been disqualified, suspended or
prohibited from practice of Medicine.
I do hereby on solemn oath state and affirm that
I am not aware of any disciplinary proceedings
against me on a ground of a defect of character or
of infamous conduct in any professional respect nor
have I been convicted of any offence implying a
defect of character.
Signature of the Applicant
Address:
