Join PHDA :: Welcome to Purva Haveli Doctors Association

DOCUMENTS REQUIRED FOR MEMBERSHIP APPROVAL

Two Passport size (3x4) Photographs with white background
Application form duly filled in completely
Additional Qualification (Post Graduate) University Certificate.
Council Registration Certificate
Additional Qualification Council Certificate
Council Renewal (Please submit your Council Renewal Certificate every Five years).
Marriage Certificate for Joint Life Membership or Change in Name.
Aadhar Card
Pan Card
Proof of Address – Only if address in Aadhar card is different than in application form

Enter Full Name

Qulification

Specialty

Council Reg. No.

MMC Validity Date:

City:

Date of Birth:

Marriage Date:

Blood Group:

Residential Address:

Pin Code:

Consulting Address:

Pin Code:

Residence Contact No.:

Consulting Contact No.:

Mobile No.:

Email ID.:

Proposed by (Name) Dr.

Signature of Applicant

Upload Certificate Document

Upload Photographs

Upload Council Registration Certificate

Upload Aadhar Card

Upload Pan Card

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