Direct Centeral Registration

Direct Centeral RegistrationIndex

Space
for Photograph
of
Candidate

FORM A

(See Regulation 4)

Form of application for direct registration under Section 23 of the Homoeopathy Central Council Act, 1973.

To

The Registrar,
Central Council of Homoeopathy. New Delhi.

Dear Sir,

I hereby request that my name and other particulars as mentioned below may be entered in the Central Register of Homoeopathy as required under Section 23 of the Homoeopathy Central Council Act, 1973.

(1) Full Name (in block letters beginning with surname)

(2) Maiden name if the applicant is a married woman and surname

(in block letters beginning with surname).

(3)Nationality.

(4)Residential Address

(5)Professional Address

(6)Date of Birth (Christian Era)

(7) (a) Qualifications for registration possessed by the applicant.

(b) Date on which the applicant obtained the qualification..

(c ) Authority which conferred or granted the qualifications..

(d) The place where the applicant received training .
for such qualifications and the period of such training..

(e)The name of the Council/Board where he had .
registered earlier, if any..

II. I forward herewith:

(i) My Birth Certificate/Matriculation Certification/Secondary School Leaving Certificate/School Leaving Certificate in original

(ii) Diploma/Degree Certificate in original in respect of the qualifications possessed by me together with two attested copies thereof.

III. The originals may kindly be returned to me after verification by you.

IV. Registration fee of Rs.1000/- (Rupees One Thousand only) is remitted by postal Order No. ________ Place /Bank Draft No._______.

V. I certify that the particular furnished above are true to the best of my knowledge and belief.

Yours faithfully,

(Signature of applicant),

Date:

Place:

N.B : The following documents/information may also be furnished.

1. Fathers Name _____________________________________________________

  Mothers Name _____________________________________________________

2. Two recent passport size photographs of applicant out of which one duly attested by a Gazetted Officer or an Officer authorized in this behalf by the Board under whose jurisdiction the applicant resides or the Principal of a recognized Homoeopathic Medical College of a member of the Legislative Assembly of the State within whose jurisdiction the applicant resides or a Member of Parliament and should be affixed on the application form.

3. Two attested copies each of the above mentioned /Diploma/Degree certificate and one copy of completion certificate of internship

4. Two attested copies of the registration certificate issued by the State Board /Council of the concerned state where you resides/practicing.

5. Copy of Oath Form (enclosed) must be signed by the applicant and duly attested by a registered medical practitioner of Homeopathy with his registration number and seal.

Declaration And Oath

At the time of registration, each applicant shall submit the following declaration and oath read and signed by him to the Registrar concerned attested by Registrar himself or by a registered practitioner of Homeopathy:-

1. I solemnly pledge myself to consecrate my life to the service of humanity.
2. Even under threat, I will not use my medical knowledge contrary to laws of humanity.
3. I will maintain the utmost respect of human life.
4. I will not permit considerations of religion, nationality, race, political beliefs or social standing to intervene between my duty and my patient.
5. I will practice my profession with conscience and dignity in accordance with principles of homeopathy.
6. The health of my patient shall be my first consideration.
7. I will respect the secrets which are confined to me.
8. I will give to my teachers the respect and gratitude which is their due.
9. I will maintain by all means in my power the honour and noble traditions of my medical profession.
10. My colleagues will be my brothers and sisters.
11. I make these promises solemnly, freely and upon my honour.

Hahnemannian Oath

On my honour I swear that I shall practise the teachings of homeopathy, perform my duty, render justice to my patients and the sick whosoever comes to me for treatment.

May the teachings of Master Hahnemann inspire me and may I have the strength for fulfillment of my mission.

(Signature of the candidate)

Name:……………………

Date:…………………….

Attested by Sign. _____________________________________________________

Name of Attesting Doctor _______________________________________________

Regn. No. & Qualification of Attesting Doctor _________________________________

Yours faithfully,

Signature of the applicant.

Date:

Place: