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UTTAR PRADESH DENTAL COUNCIL

5, Sarvapalli, Mall Avenue Road, Lucknow

REGISTRATION CERTIFICATE OF{{credentialSubject.courseName}}

Certificate No :

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Roll No :

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This is to certify that the person named below has been registered as a {{credentialSubject.courseName}} in the Uttar Pradesh under the provision of Dentists' Act, 1948

Registration in Part

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Name

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Mother's Name Smt.

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Father's Name Sri.

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Qualification with particulars

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Date & Place of registration

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Address

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This certificate shall remain in force up to :-

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Born

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Fee Recei[t No.

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U.P. Dental Council has the right to cancel the certificate, if any information is found to be incorrect or fake.