Final Certificate Application

SHEKHPARA EAJPUR, 24 PGS (N), W.B., 743424

WEST BENGAL ELECTROPATHY
MEDICAL COUNCIL

FINAL CERTIFICATE APPLICATION

To the Principal,

My humble request is, please register me in your organization.

Student Final Certificate Form

Name Of The Student (Block Letter) :

Course :

Father’s / Husband Name :

Mother’s Name:

Permanent Address Village / Ward :

P.S. :

P.O :

Dist :

Pin :

State :

Date of Birth :

Age :

Gender :

Cast :

Religion :

Aadhaar Card No :

Nationality :

Educational Qualification :

Mobile No :

Email ID :

Institute name :

Student Regd. Certificate :

Choose File

N.O.C. for Principal :

Choose File

Trade Licence with Signature of Candidate :

Choose File

Medical Admit Cards :

Choose File

Aadhar Card Both Side :

Choose File

Clinic Name & Address :

Choose File

Medical Mark Sheets :

Choose File

Residence GP/Municipality :

Choose File

Father & Mother ID Proof :

Choose File

Photo :

Choose File

Application Fee Receipt :

Choose File

Internship Certificate :

Choose File

Student should follow the rules and regulation of the council.

WEST BENGAL ELECTROPATHY MEDICAL COUNCIL

FINAL CERTIFICATE APPLICATION

WEST BENGAL ELECTROPATHY
MEDICAL COUNCIL