PARAMEDICAL COUNCIL (PUNJAB) MOHALI
Application for Registration of Para Medical Personnels
1. Name & Address of ____________________________________________________
The Application
____________________________________________________
____________________________________________________
Landline No.
____________________________________________________
Mob. No.
____________________________________________________
E-mail
____________________________________________________
Fax
____________________________________________________
2. Address to which
____________________________________________________
Communication
____________________________________________________
are to be sent
____________________________________________________
3. Date of Birth
____________________________________________________
4. Nationallity
____________________________________________________
5. Sex
____________________________________________________
6. Father's Name
____________________________________________________
7. Official Address
____________________________________________________
____________________________________________________
____________________________________________________
8. Educational Qualification
____________________________________________________
9. Experience
____________________________________________________
10. Details of Remittance of
Registration Fee
____________________________________________________
Date and No. of receipt or
D.D No.& Date
____________________________________________________
Instructions
1. Registration will not be allowed if the diploma course were issued form
institution not affiliated by the Para Medical Council (Pb) Mohali.
2. Registration fee will not be refundable at any reason.