Haryana State Dental Council

Form of application for registration of dentist

General Info

Sub-Part

* Reg.No.

* First Name

Middle Name

* Last Name

* Pref Name

Father Name

Mother Name

* Date of Birth

Birth Place

* Gender

Blood Group

Nationality

Qualification Details

Basic Qualification

* Basic

* University

* College

* Passing Year

* Internship Date

* P.G.Qualification

* Specialization

* University

* College

* Passing Year

* Date

Address for Communication

* Presently Not In Dental Professional :

Permanent Address
Communication/Professional

* Preffered Address

* Address

Address 1

Address 2

* Country

* State

* City/District

Taluka

Village

* Area

* Pincode

Tel

Tel 1

Ext. No.

Fax

Contact Info

* Mobile 1

Mobile 2 / Whats App No.

* Email 1

Email 2

Website

Photo Identity

Type

Number

DCI Order

SDC

DCI NOC No.

46A DCI Date

* Note 1 -

"By becoming an SDC member / submitting this application form, you are indicating your consent to receiving SMS and Email messages, Reminders, Information from SDC about Dentistry, Activities , Conferences & Exhibitions and Continuing Dental Education programmes".

* {{record.Name}}

Your New Registration Appointment has been taken successfully. Please Visit SDC Office with your token no {{TaskId}}

Amount

Select	Amount
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IGST

CGST

SGST

Total Fee

Remark

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