E-mail : telanganamedicalcouncil@gmail.
com Phone : 040-24657639
[email protected] Mobile : 8125828958, 7842707925
Website : www.tsmconline.in
Application for Final Medical Registration with Recent
TELANGANA STATE MEDICAL COUNCIL Passport Size
DM & HS Campus, Sultan Bazar, Hyderabad - 500 095. Photograph Affixed
To, and Attested by
The Registrar, Principal of
TELANGANA STATE MEDICAL COUNCIL Medical College
Sultan Bazar, Hyderabad - 500 095. concerned
Sir,
I have the honour to request that my name, address and qualifications as stated below may be
registered under the Telangana State Medical Practitioners Registration (Amendment) Act, 1968 (Telangana
Adaptation) order, 2015 and that I may be furnished with a certificate of Registration.
Full Name (Including Surname) ............................................................................................................................
Father’ s Name...........................................................Mother’s Name...................................................................
Date of Birth......................................................Gender.......................Blood Group..............................................
Permanent Address...............................................................................................................................................
........................................................................................................Pincode..........................................................
E-mail ID .................................................................................Phone: .................................................................
Aadhar Card No:....................................................................................................................................................
Medical Qualification of which Registration Medical College and place where Month and Year of
is required, Name of the University each was obtained Internship Completed
The Originals and the copies of required papers are submitted herewith. The originals may kindly be
returned when no longer required.
The above facts are true to the best of my knowledge. Yours faithfully,
(Signature of the Doctor)
1. Fee Rs. 4,150/- (Postal charges included). In case of Tatkal Additional fee Rs. 2,000/- UPI and card Payments are
accepted. Additional Rs.100/- are charged for card transaction at offline application submission.
2. MBBS Degree in Original signed by Principal and its copy
3. Internship Certificate in Original signed by Principal and its copy.
4. Provisional / Temporary Registration Certificate and its copy
5. Proof of Date of Birth Original and its copy (SSC)
6. Candidate must present in person with one passport size photo.
7. In case from other state candidates, latest N.O.C. Registration Certificate and
Degree Certificate should be enclosed
8. Affidavit for delay of 3 months and two testimonials in the prescribed form in case of 6 months delay.
9. Late fee - in case of delay - beyond one year including Affidavit and two testimonials.
10. Ethics Awareness Programme Certificate.
11. Identity Card (if required) Charges in cash Rs.100/-
12. For Tatkal applicants Registration Certificate will be handover by hand by the Registrar only. For others it will be
sent by post.
13. An undertaking should be submit on Rs. 10/- stamp paper stating that the documents submitted by the candidate
is genuine, if any false information provided by them they may be liable and the Council is at liberty to cancel the
Registration.
D.D.No. Date : For Rs.
REGISTRAR
