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UTTAR PRADESH DENTAL COUNCIL

5, Sarvapalli, Mall Avenue Road, Lucknow

(Issued under section 32(2) / 35(4) of the Dentists Act, 1948)

UTTAR PRADESH PROVISIONAL (DENTIST'S) REGISTRATON CERTIFICATE

(This certificate must be surrendered on expiry)

Certificate No :

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Dated :

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This is to certify that the person named below has been registered as a DENTIST 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

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Year of Passing

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College

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University

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Date & Place of registration

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Address

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Valid only foryear's compulsory rotatory internship at the INSTITUTE OF DENTAL STUDIES & TECHNOLOGIES & HOSPITAL, MONDINAGAR And for no other purpose.

Place

:

Lucknow

Born

:

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Fee

:

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Corrected on

:

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Correction Fee receipt 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.

Caution: Permanent registration will given only after the surrender of this certificate.