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Affidavit

The document is an affidavit for medical graduates who have delayed their registration with the Medical Council of India after completing their internship. It includes personal details, the duration and location of their internship, reasons for the registration delay, and a declaration of ethical conduct. The affidavit must be sworn and attested by a magistrate or notary on non-judicial stamp paper.

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434 views1 page

Affidavit

The document is an affidavit for medical graduates who have delayed their registration with the Medical Council of India after completing their internship. It includes personal details, the duration and location of their internship, reasons for the registration delay, and a declaration of ethical conduct. The affidavit must be sworn and attested by a magistrate or notary on non-judicial stamp paper.

Uploaded by

HALF BLOOD PRINCE
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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(AFFIDAVIT IN THE FOLLOWING FORMAT ON NON-JUDICIAL STAMP PAPER OF RS.

100/-
DULY SWORN IN AND ATTESTED BY FIRST CLASS MAGISTRATE / NOTARY FOR DELAY IN
APPLYING FOR REGISTRATION IN CASE DELAY IS MORE THAN ONE MONTH AFTER
COMPLETION OF INTERNSHIP TRAINING.)

I DR.________________________________________ S/O SH. _______________________________________________ R/O


_________________________________________________________________ DO HEREBY SOLEMNLY AFFIRM AND DECLARE
AS UNDER :-

1. THAT I WAS A STUDENT OF MBBS OR CORRECT NOMENCLATURE OF QUALIFICATION IF OTHER THAN


MBBS AT ______________________________________________________ MEDICAL COLLEGE FROM _______________________
TO ________________________

2. THAT I HAVE COMPLETED MY COMPULSORY INTERNSHIP TRAINING


FROM __________________________________________ TO __________________________________

3. THAT I HAVE COMPLETED MY COMPULSORY INTERNSHIP TRAINING FOR ONE YEAR /


________________________________________________________________ ( OR MORE AS THE CASE MAY BE ) AT
____________________________________________________ (DETAILS OF HOSPITAL WITH COMPLETE ADDRESS.)

4. THAT I COULD NOT GET MYSELF REGISTERED WITH M.C.I. DUE TO


__________________________________________________________________________________________________________________
_________________________________________________________________________________________ (SPECIFIC REASON FOR
THE DELAY MUST BE SPELT OUT BY THE CANDIDATE ALSO OF OTHER STATE COUNCIL.)

5. THAT I HAVE NO DONE ANY UNETHICAL PRACTICE AFTER COMPLETION OF ANY INTERNSHIP TRAINING.
HOWEVER, IF ANY COMPLAINT IS MADE AGAINST ME FOR UNETHICAL PRACTISE DURING THIS PERIOD,
I SHALL BE HELD RESPONSIBLE FOR THE SAME.

6. THAT ALL THE FACTS STATED ABOVE ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.

DEPONENT.

VERIFICATION :

VERIFIED AT _____________________________ THIS __________________________ DAY OF ___________________________________


THAT THE CONTENTS OF THIS AFFIDAVIT ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE
AND BELIEF.

DEPONENT.
(WITH PHOTO OF CANDIDATE)

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