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Facce Form

The document is a registration form for medical professionals, requiring personal details, educational background, and specialty selection. It lists necessary documents to attach, including degrees and experience certificates, and provides contact information for fee inquiries. Applicants must send the completed form and documents to Dr. Praveen Aggarwal at the All India Institute of Medical Sciences in New Delhi.

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poojan
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7 views1 page

Facce Form

The document is a registration form for medical professionals, requiring personal details, educational background, and specialty selection. It lists necessary documents to attach, including degrees and experience certificates, and provides contact information for fee inquiries. Applicants must send the completed form and documents to Dr. Praveen Aggarwal at the All India Institute of Medical Sciences in New Delhi.

Uploaded by

poojan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Registration Form:

Affix a
FACEE or MACEE (Circle One)
photograph
First Name (Block Letters)

Last Name (Block Letters)

Date of Birth: DD/MM/YYYY

Background Degree: MBBS/MD / MS / DNB (Circle One or Maximum Two)

Specialty: (Circle One)


Plain MBBS, Emergency Medicine, Medicine, Pediatrics, Surgery, Orthopedics, Pulmonary Medicine, Family
Medicine, Anesthesia, OB/GYN

Cell Phone:

Email:

Current designation:

Residential Address:

College/Hospital/Clinic Address:

Documents to be attached:
1. Registration form with a photograph
2. Copy of MBBS degree
3. Copy of MD/MS/DNB degree (if applicable)
4. Copies of experience certificates including current position
5. Brief Curriculum vitae including current and past positions held

For Details of fees, please contact:


Dr Praveen Aggarwal
Department of Emergency Medicine
All India Institute of Medical Sciences
New Delhi – 110029

Email: peekay_124@hotmail.com
Tel: 9868397050; 9810090693

DD Should be in favour of “ACEE” payable at Delhi (Fee amount will be communicated by Dr. Praveen Aggrawal)

Please mail all the registration form, documents, and demand draft along with a photograph to above address.

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