Application Form for "Maharashtra Medical Council Awards - 2015"
to be filled by Organisation / Institute / Association
  • Before filling the application please read the gudeline of Awards carefully

    • Part-I

    Registration Number With Charity Commissioner * : Accrediation Number of Organization/ Association /Institute (given by MMC) * :
    Name Of the Organization/ Association/Institute * : Address * :
    Tel. No. * : E-Mail Id * :

    Person to be Nominated Details:

    Part- II
    MMC Registration No * : MMC Registration Date * :
    Name Of the RMP to be Nominated * :
    Adress : Date of Birth :
    Email Id : Mobile No :
    Registration Valid upto  Date * : Gender * :
    Category * :    
    Document Name * :      
    Upload Documents  * :    
    Note : Attached documents should not be more than 50 page
    Name of Recommending President/Chief of the Organization :
    P9qHeP
    		Change Image
    Enter Above Displayed Characters *
    Note :
    1)Maximum one male and one female nomination from single organization for each category will be accepted.
    2) Document uploaded will be in .jpg format only and should not be more than 100 kb.
    3) If there is any difficulty in filling the form, contact:- Tel. No:-022-23010668, 022-23072464. E-mail Id- maharashtramcouncil@gmail.com
    4) Last Date for receipt of Nomination form : 30/11/2015 At 05.00 PM
     
    Contact  for any Technical support:- Tel.No.  022 25667503