Membership Certification

Applying For Registration*

Board/Institute/University*

Passing Year*

Total Marks*

Obtained Marks*

Educational Qualification (Except for Registration Applied)

#	Name Of The Course	Name of the Institute/College/University	Study Period	Passing Year
1
2
3
4
5

Work Experience (If Any)

Candidate Full Name*

Father Name*

Mother Name*

Date Of Birth*

Email Address*

Contact Number*

Gender*

Category*

Address*

City*

State*

Country*

Pincode*

I accept DECLARATION.

DECLARATION : -

I hereby declare that the above statement are true to the best of my knowledge and belief and the I am free from the disqualification menontied in the Delhi State Government Paramedical Council. I promise in the event of being registered and in consideration thereof to be bound by and to conform in all respects to the rules, regulation etc. framed by Council form me to me in force.