CCH INDIA

"In the treasury of nature, there are many Gems; those only are worth carrying away, which we know how to set" --Honigberger

Non Inutilis Vixi (Not lived in vain)
Dr. C. F. Samuel Hahnemann

Registration Form

Registration FormIndex

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.

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:-

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

FORM B

(See Regulation 5)

Form of application for registration of additional qualification.

The Registrar,

The Central Council of Homoeopathy,

New Delhi.

Dear Sir,

I am a registered practitioner of Homoeopathy my Registration Number is ______I have acquired an additional qualification in Homoeopathy and desire to register the same under Regulation 5 of the Homoeopathy Central Council (Registration) Regulations, 1982. My particulars are as under:-

1.(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) Additional qualifications sought to be entered in the register.

(a)The authority which conferred or granted the additional qualification.

(b)The date on which the qualification was conferred/granted.

(c) Details of training leading to conferment of the additional qualification, including the period of such training.

(8) Number and date of registration in the Central Register.

(9) Number and date of registration in the State Register,.

II. I forward herewith:

(i) the additional Title/Diploma/other qualification (in original).

(ii) two attested copies thereof, attested by one of the persons referred to in clause (iii) of sub-regulation (2) of regulation 4 of the Homoeopathy Central Council (Registration) Regulations, 1982..

(iii) A fee of Five Hundred Rupees only (including service charges of Sixty Rupees ) by crossed Postal Order/Bank Draft in the name of – “The Central Council of Homoeopathy, New Delhi”..

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

Yours faithfully,

Signature of the applicant.

Date:

Place:

FROM F

[See Regulation 9(2) and (3)]

Application for the continuation of name in the Central Register

Dated_________

The Registrar,

Central Council of Homoeopathy,

New Delhi.

Sub:- Continuation of name in the Register.

Sir,

I request that my name may be continued in the Central Register maintained by the Central Council in Part _____________.

1. My particular are submitted as under:-

(i) Full Name (in block letters beginning with surname).

(ii) Maiden name in full in case of an unmarried woman (in block letters beginning with surname).

(iii) Registration No.

(iv) Date upto which it is renewed,

(v) Qualification possessed at the time of initial registration.

(vi) Permanent address for correspondence.

3.*A restoration fee of Rs. 75/- (Rs. 25/- for restoration and Rs. 50/- as service charges) is enclosed by way of crossed Postal Order/Bank Draft in the name of the Central Council of Homoeopathy, New Delhi.

Yours faithfully,

Signature

Full Name

Date:

“Note:- The fee of Seventy five rupees shall be for restoration of the registration, and not for the purpose of renewal of registration”

FROM G

(See regulation 10)

Appeal for restoration of name in the Register.

The Secretary

to the Govt. of India

Ministry of Health and Family Welfare,

New Delhi.

I , the undersigned _________________________________________ (full name in block letters beginning with Surname) holding qualification of _________________do solemnly declare that the following are (state the qualification) the facts of my case on which I seek restoration of my name in the Register:

2. My name was duly registered in the State Register of (___________________)having (name of the State) registration number __________dated___________.

3. My name was duly registered in the Central Register of Homoeopathy on ___________having registration No._____________

4. At an enquiry held on the _________day of ___________by the Board, my name was directed to be removed from the State Register and the offence for which the Board directed the removal of my name was _______________(use separate sheet for details if necessary).

5. Since the removal of my name from the Register I have been residing at __________and my occupation has been ____________.

6. It is my request that my name be restored in the Register of _________State.

7.The grounds, for the present, of application are

(i)

(ii)

(iii)

8. The prescribed fee of Rs. 75/- (Rs. 25/- for restoration and Rs. 50/- as service charges) has been deposited by Bank Draft No.________dated_______ payable to Secretary, Ministry of Health and Family Welfare, New Delhi.

9. I request that orders may be passed for restoration of my name in the State Register of _____________(State)

Signed________

On_____________

Declared at ___________

before me__________

Judicial/Executive Magistrate,
Commissioner of Oath