The duty ofa practitioner to the people is to render Professional Service andhe/ she mustpossess appropriate knowledge and skills inmodem system ofmedicine andsurgery which must be continuously improved and must discharge his/her duty within the guiding principles of professional Conduct, Etiquette and Ethics. Arunachal Pradesh Medical Council shall stand for all the above.
T. Bagra Secretary (Health & FamilyWelfare) Government ofArunachal Pradesh Itanagar.
AddressSI. Name Father's Mother's Gender Nationality Date ofbirth Residential Permanent ProfessionalNo. Name/ Name (dd/mm/yy) Address Address AddressHusband's Name I 2 3 4 5 6 7 8 9 10 Telephone Category QualificationNo./ (General/ General Degree Medical DegreeFax No./ APST) Description Institution Board/ Yearof Description Medical Board/ Year ofE-mail ID ofQuali Univer Qualifi ofQuali College/ University/ Qualifification sity cation fication lnstitu- Licensing cation/ tion Body comple tionof InternshipII 12 13 14 15 16 17 18 » 20 Photograph of the registered practitioner APPENDIX-A (See Rule 24) Arunachal Pradesh Medical Council FORMAT FOR REGISTER OFMEDICAL PRACTITIONERS The Arunachal Pradesh Extraordinary Gazette, February 12, 2007 12 Initial of Remarks Registrar MCI Registration, Registration in other state, APMCRegistration I Iif any if any Date of Registration Date of Registration Authority under Date Registrati:,Registra- No. Registra No. whom registered No.tion tion ...21 22 23 24 25 26 £7. 28 29 - .
Removal from RegisterInitial Remr k:.
of Registrar Other State/ APMC Initial Central r of ' Registrar le of r Date Reason. Date Reason Iin MC / ister i ·-I ..
37 38 39 40 41 t 35 36 Da entry AP Reg I I I I I Additional Qualification Degree Year Medical Board/ of College/ Council/ Quali lnstitu- Univer fication tion sity/ Licensing Body 30 31 32 33 a.Restoration ofName in the Ri sfer Initial of Remarks Renewal Initial of Remarks Registrar RegistrarOther State/ Central APMC Renewal Renewed i Due date onDate Reason Date Reason 42 43 44 45 46 47 48 49 50 51r TheArunachal Pradesh Extraordinary Gazette, February 12, 2007 13 To, FORM-I (See Rule 25, 26) Arunachal Pradesh Medical Council Application form for Direct Registration Rece iptNo .
Date .
(For office use) The Registrar, Arunachal Pradesh Medical Council, Nahar lagun.
Affix passport size photograph attested Sir, I hereby request that my name and other particulars mentioned below may be entered in the State Register of Arunachal Pradesh Medical Council as required under section-IO ofArunachal PradeshMedical Council Act 2004 (Act No.4 of2004).
I. Name of the Applicant (in block letters)
2. Father's/ Husband's Name
3. Mother's Name
4. Gender
5. Nationality
6. Date ofBirth (date, month , year)
7. Address
(a) Residential Address
(b) Permanent Address
(c) Professional Address
8. Telephone No./Mobile No./Fax No./ E-mail ID
9. Category (General/ APST) 10 Qualifications :
(a) General Degree
(b) Medical Degree SI. Description of Name of the School/ Name of the Year ofNo. Qualification College/ Institution Board/University Qualification
11. Details oflnternship (include separate sheet, if require)
12. MCI Registration No. & Date (if any) SI. Description of Nameofthe Name of the University/ Year of Qualification/No. Qualification College/ Institution Licensing Authority completion of lnternshin- 14 TheArunachal Pradesh Extraordinary Gazette, February 12, 2007
13. (a) Registration No. & Date, if any in other State
(b) Authority under whom Registered
14. (a) Bank Draft No. & Date
(b) Draft Prepared from (Bank) I submit herewith original certificates for verification and submit attested copies of the same certificates:-
(a) Ifregisteredelse where (MCI andotherState).
(i) Birth Certificate/Matriculation Certificate/SSC Exam certificatewith dateof birth.
(ii) MBBS Degree/ Post Graduate Degree/ Diploma/ Post Doctoral Degree/ any other.
(iii) StateMedical Council/Medical Council oflndiaRegistration Certificates with MBBS Qualification.
(iv) Original Internship Completion Certificate.
(v) Other evidence in support ofmy having obtained the qualification which I possess.
(vi) No Objection Certificate from StateMedical Council whereearlier registered.
(vii) Three recent passport size photographs with name and signature at the backside.
(viii) Bank Draft Rs. 1000/-(Rupees one thousand) in favourof"Arunachal Pradesh Medical Council" payable at Naharlagun (non-refundable).
(b) In case offresh registration.
(i) Birth Certificate/Matriculation Certificate/SSC Exam Certificatewith date of birth.
(ii) MBBS Degree/ Post Degree/ Diploma/ Post Doctoral Degree.
(iii) Original Internship Completion Certificate.
(iv) Other evidence in support ofmy having obtained the qualification which I possess.
(v_) Three recent passport size photographs with name and signature at the backside.
(vi) BankDraft for Rs. I 000/-(Rupees one thousand) in favourof"Arunachal Pradesh Medical Council" payable at Naharlagun (non-refundable).
DECLARATION I solemnly affirm and declare that the particulars furnished above by me are true to the best ofmy knowledge and belief and I undertake to abide by the code of conduct & Ethics ofArunachal Pradesh Medical Council and Indian Medical Council and by the Rules ofArunachal Pradesh Medical Council.
Date: .
Received the above documents in original.
Signature of the Applicant.
(for office use only) Signature ofregistered person .
Name .
Date .
TheArunachal PradeshExtraordinaryGazette, February 12, 2007 FORM-2 (SeeRule 27) Arunachal PradeshMedical Council Registration Certificate Office ofArunachal PradeshMedical Council Logo Naharlagun CERTIFICATE OFREGISTRATION Passport size photograph ofthe registered practitioner 15 This is to certify that :-[ RegistrationNo .
1. Dr (whose sign is in the box) I I , son/ daughter/wife of .......................................... born on ./ ./ (date, month, year~ possessing the qualification(s) has beendulyregisteredundertheArunachal Pradesh Medical CouncilAct.2004 (Act. No.4of2004).
2. Dr has solemnlyaffirmedto abide bythe Rules andRegulations of Arunachal PradeshMedical Council Rules, 2006 and ethics ofArunachal Pradesh Medical Council andIndianMedical Council (professional conduct, etiquette andethic) Regulations, 2002'.
3. Inwitness whereof, the seal ofthe Arunachal PradeshMedical Council and the signature ofthe Registrar is herewith affixed.
4. Subject to the provisionofthe saidAct this certificate is validupto a periodof5 (five) years from this date.
Date · .
ADDITIONALQUALIFICATION:
Signature ofRegistrar With seal SI.No. DescriptionofQualification Date ofRegistration Signature ofRegistrar inAPMC Register with seal Registration Renewed :
Date: Renewal sea) Signature ofRegistrarwith seal ImportantNotice: !. Registered Medical practitioners should sent immediate notice to the Registrar ofArunachal Pradesh Medical Council ifthere is any change.in the registeredaddress.
2. The Registrationmust be renewed before the expiry of5 (five) years from the date oflast registrationor renewal.
3. After the publication ofnames in the printedmedical Register, the last addition ofthe Register alone is the legal evidence ofRegistration.
4. The Registeredpractitioner shall displaythe Certificate ofRegistration in a conspicuous part in the place ofhis/her practice, ifhe or she hasmore than one such places, in any one ofthem.
16 TheArunachal Pradesh Extraordinary Gazette, February 12, 2007 FORM-3 (SeeRule28, 29 (ii)) Arunachal Pradesh Medical Council APPLICATION FORM FOR CONTINUATION OF NAME IN THE REGISTER ReceiptNo .
Date .
(For office use) To, TheRegistrar, Arunachal Pradesh Medical Council, Naharlagun.
Sub:- Continuation ofname in theRegister Sir, Affix passport size photograph attested 1 request thatmy namemay becontinued in the StateRegister maintained byArunachal Pradesh Medical Council.
I. NameoftheApplicant (in block letters)
2. Mother's Name
3. Father's/ Husband's Name
4. Gender
5. Date of Birth (date, month, year)
6. Nationality
7. Category (General/APST)
8. (a) Residential Address
(b) Permanent Address
(c) Professional Address
9. TelephoneNo./MobileNo./ Fax No./ E-mail ID I0. Details ofQualifications SJ. Description ofQualification Name of the School/ NameoftheBoard/ Year ofthe completion No. College/ Medical Institution University/ of Internship in case Licensing body ofMBBS in any other case year of passing examination.
I1. Arunachal Pradesh Medical Council Registration CertificateNo. & Date
12. Present Occupation I submit herewith original certificates for verification and submit attested copies of the same certificates:
(a) Two recent passport size photographs with name and signature at the backside.
(b) Arunachal Pradesh Medical Council Registration Certificate.
(c) MBBS Degree/ Post Graduate Degree/ Diploma/ Post-Doctoral Degree Certificate.
I hereby submit a Bank Draft No Dated prepared from (Bank) for Rs.1000/- (Rupees one thousand) as non-refundable fee in favourof "Arunachal Pradesh Medical Council" payable at Naharlagun.
1 hereby submit a Bank Draft No...
.......for Rs...........
Medical Council" payable at Naharlagun.
(in case oflate fee) .................... Dated prepared from (Bank) . . being the late fee asnon-refundable in favourof"Arunachal Pradesh DECLARATION I solemnly affirm and declare that the particulars furnished above by me are true to the best ofmy knowledge and belief and I undertake to abide by the code of conduct & Ethics ofArunachal Pradesh Medical Council and Indian Medical Council and by the Rules ofArunachal Pradesh Medical Council.
Date:
Received the above documents in original.
Signature of theApplicant (for office use only) Signatureofregistered person .
Name .
Date .
TheArunachal PradeshExtraordinaryGazette, February 12, 2007 FORM-4 (See Rule 29 (!)(ii)) Arunachal PradeshMedical Council 17 Form for General Notice General Notice is hereby given to all the Registered Practitioners included in the State Register ofArunachal PradeshMedical Council under theArunachal PradeshMedical CouncilAct, 2004 (ActNo.4 of2004) whose validation ofRegistration i.e. 5 years have been completed, they have to make an application to the Registrar for continuance of their names in the said Register as provided in Rule 29 ()(ii) oftheArunachal PradeshMedical Council Rules, 2006.
Individual notices alongwith the prescribed form ofapplication are being sent under Certificate ofposting to every such Registered Practitioner to the address in the saidRegister. An application in Form-2 for continuation ofthe name in the Register shouldbe returned to the undersigned duly completedwithin45 days ofthe issue ofthe notice. Any Registered Practitioner not receiving the form by postmay obtain it from the office ofthe Registrar.
Date:
Registrar, Arunachal PradeshMedical Council, Naharlagun.
FORM-5 (See Rule 29 (1)) Arunachal PradeshMedical Council Notice for continuation ofName in the Register To, Dr ..
Sub:- Individual Notice for continuation of name in the Arunachal Pradesh Medical Council Register.
Sir, Notice is hereby given to you callingupon youto return the enclosed application form (Form No.2) dully filled in by you to the Registrar within 45 (forty five) days for continuation ofyour name in the state Register ofArunachal PradeshMedical Council.
Yours faithfully, Registrar, Arunachal PradeshMedical Council, Naharlagun.
18 The Arunachal Pradesh Extraordinary Gazette, February 12, 2007 FORM-6 (See Rule 29 (3)) Arunachal Pradesh Medical Council APPLICATION FOR REGISTRATION OFADDITIONAL QUALIFICATION(S) ReceiptNo .
Date .
(For office use) To, The Registrar, Arunachal Pradesh Medical Council, Naharlagun.
Sub:- Registration ofadditional qualification Affix passport size photograph attested Sir, I am a registered practitioner of Arunachal Pradesh Medical Council and my Registration No. is ........................... I have acquired an additional qualification in modern systemofmedicine and desire to register the same. My particulars are as under : SI. Description of Name of the College/ Name ofthe University/ Year of obtaining No. Qualification Medical Institution Licensing body the qualification I. Name of the Applicant (in block letters)
2. Mother's Name
3. Father's/ Husband's Name
4. Gender
5. Date ofBirth (date, month, year)
6. Nationality
7. Category (General/ APST)
8. (a) Residential Address
(b) Permanent Address
(c) Professional Address
9. Telephone No./ Mobile No./ Fax No./ E-mail ID
10. Nomenclature ofAdditional Degree/ Diploma obtained with the name of the University/ Licensing Body and the year of obtaining the qualification. The subject of post graduation(s) should also be indicated:
I hereby submit a Bank Draft No .Dated . . . . . . . . . . . . . . . . . . . . . . ......obtained from (Bank) for Rs.500/-(Rupees five hundred) as non-refundable fee in favour of "Arunachal Pradcsh Mcdical Council" payable at Naharlagun.
DECLARATION 1 solemnly affirm and declare that the particulars furnished above by me are true to the best ofmy knowledge and belief and I undertake to abide by the code of conduct & Ethics ofArunachal Pradesh Medical Council and Indian Medical Council and by the Rules ofArunachal Pradesh Medical Council.
Date:... Signature of the Applicant.
Note:
I. Copies of relevant additional qualification may be submitted with this application along with originals, which would be returned after verification.
2. Only post graduate qualification(s) recognised by the Medical Council oflndia would be entered in the register.
3. Entries of additional qualification(s) would be entered only for those persons who possess a registerable basic medical qualification as included in the schedule to the Indian Medical Council Act 1956.
4. The certificate of Registration with Arunachal Pradesh Medical Council shall be required to be submitted, in original, with this application.
5. Two recent pass port size photographs with name and signature at the backside.
6. Bank Draft for Rs. I 000 /-(Rupees one thousand) in favour of"Arunachal Pradesh Medical Council" payable at Naharlagun (non refundable) (for office use only) Received the above documents in original.
Signature ofregistered person .
Name .
Dale .
The Arunachal Pradesh Extraordinary Gazette, February 12, 2007 FORM-7 (See Rule 29 (6)) Arunachal Pradesh Medical Council APPLICATION FOR RESTORATION OF NAME IN THE REGISTER 19 To, The Registrar , Arunachal Pradesh Medical Council, Nahar lagun.
Sub:- Restoration of name in the Register.
Sir, ReceiptNo ..
Date .
(for office use only) Affix passport size photograph attested I. I, the undersigned (full name andaddress) holding qualification of.. do solemnly declare that the following are facts ofmy case on which I seek restoration ofmy name in the Register.
2. My name was duly registered in the State Register of having registration number....................................... (Name of the State) ..
dated ..
3. My name was duly registered in the State Register of Arunachal Pradesh Medical Council on .................................... having registration number .
4. At an enquiry held on the day of.. by the Council/ Board/ Committee of ................................................... my name was directed to be removed from the State Register and the offence(s) for which the Council/ Board/Committee of directed removal ofmy name wasl1M:re... . .. . . . . . . . . . . . . . . . .. . . . . . . . ..
5. Since the removal ofmy 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 Registerof State.
7. The grounds for the present application are:
@)
(ii)
(iii)
8. The prescribed fee of Rs. 1000/- (Rupees one thousand) deposited by Bank Draft No dated in favourofArunachal Pradesh Medical Council payable at Naharlagun.
9. I request that orders may be passed for restoration of my name in the State Register of .......................... : (State).
IO. I submit three recent passport size photographs.
11. I submitArunachal Pradesh Medical Council Registration Certificate in original.
Declared at .
Before .
Received the above documents in original.
(for office use only) Signature Signature ofregistered person .
Name .
Date ..
(Instructional) : All facts and the grounds on which the application is made should be clear ly and concisely stated.Use separate sheets if necessary ) 20 TheArunachal Pradesh Extraordinary Gazette, February 12, 2007 FORM-8 (See Rule30 (@)) Arunachal Pradesh Medical Council APPLICATION FOR PROVISIONAL REGISTRATION ReceiptNo .
Date .
(for office use) To, TheRegistrar, Arunachal Pradesh Medical Council, Naharlagun.
Sub:- Provisional Registration.
Affix passport size photograph attested SI Description ofQualification Name of the School/ Name of theBoard/ Yearof No. College University Qualification Sir, I hereby request that my name and other particulars mentioned below may be entered in the State Provisional Register of Arunachal Pradesh Medical Council as required under section 9 (2) of the Arunachal Pradesh Medical Council Act 2004 (Act No.4 of2004).
I. Nameof theApplicant (in block letters)
2. Mother's Name
3. Father's/ Husband's Name
4. Gender
5. Date of birth (date, month, year)
6. Nationality
7. Category (General/APST) 8 Address
(a) Residential Address
(b) Permanent Address
9. TelephoneNo./MobileNo./ Fax No./ E-mail ID
10. Details ofQualification:
(a) General Degree:
(b) Medical Degree:
SI. Description of Roll No/ NameoftheMedical Name of the University/ Year of No. Qualification Registration No. College/ Institution Licensing Authority passing II. Name of the Institution where applicant has been selected for practical training (whether the Hospital or Institution) where such training is to be undertaken is recognised by the Medical Council oflndia.
12. Name oftheMedical College attended I hereby submit a Bank Draft No Dated obtained from (Bank) for Rs.500/-(Rupees fivehundred) asnon-refundable fee in favourof"Arunachal Pradesh Medical Council" payable at Naharlagun.
DECLARATION I solemnly affirm and declare that the particulars furnished above by me are true to the best ofmy knowledge and belief and I undertake to abide by the code of conduct & Ethics ofArunachal Pradesh Medical Council and Indian Medical Council and by the Rules ofArunachal Pradesh Medical Council.
Date:.
Note:
I.
2.
3.
4.
Signature of theApplicant.
Application to be submitted at the office of the Arunachal Pradesh Medical Council along with three recent passport size photographs.
Provisional degree/ diploma or provisional certificate of having passed theMBBS examination issued by the Dean of theCollege/ University in original along with relevant copies be forwarded with this application. The original will be returned with the provisional certificate ofregistration.
Certificate of date of birth Bank Draft for Rs.500/- (Rupees five hundred) in favour of "Arunachal Pradesh Medical Council" payable at Naharlagun (non refundable).
Received the above documents in original.
(for office use only) Signature ofregistered erson .
Name .
Date .
The Arunachal Pradesh Extraordinary Gazette, February 12, 2007 21 FORM-9 (See Rule 30 (ii)) Arunachal Pradesh Medical Council FORM FOR CERTIFICATE OF PROVISIONAL REGISTRATION Office ofArunachal Pradesh Medical Council Logo Naharlagun Passport size photograph of the registered practitioner CERTIFICATE OF PROVISIONAL REGISTRATION Provision Ristration No .
This is certify that ( who has signed in the box I I , son/ daugh ter of Sri/ Smti... ... ... ... ... having passed the final MBBS-examination on ................................... (date) from (Medical College) affiliated to the University of has been given Provision Registration under theArunachal Pradesh Medical CouncilAct, 2004, for the purpose ofpractical training (Internship/ ), . *Ill ........................•.......................
In witness whereof, the seal of the Arunachal Pradesh Medical Council, Arunachal Pradesh and the signature of the Registrar are herewith affixed.
Subject to the provisions of the said Act, this certificate is valid upto or the completion of the Internship, whichever is later.
This holder shall be entitled to practice medicine in the approved institution for the purpose of such tra ining and for no other purpose.
Date ..
Signature ofRegistrar With seal Institution/ Hospital N.B::- This certificate is to be surrender to the Council at the time of Final Registration.
22 The Arunachal Pradesh Extraordinary Gazette, February 12, 2007 Appendix-B (See Rule 30 (iii)) Arunachal Pradesh Medical Council FORMAT FOR PROVISIONAL REGISTER OF MEDICAL PRACTITIONERS SI.No. Name Mother's Father's Gender Date of Nationality Category Address Name Name/ birth (General/ Residential Permanent Husband's (dd/mm/yy) APST) Address Address Name I 2 3 4 5 6 7 8 9 10 Telephone Qualification No.I General Degree Medical Degree Fax No./ Description Institution Board/ Year of Description Medical RollNo./ Board/ Yearof E-mail ID of University Qualifi- of College/ Registra- Univer- Quali fi- Qualifica- cation Qualification Institution tion No. sity cation tion LicensingBody II 12 13 14 15 I6 17 18 19 20 Hospital/ Institution selected for Name ofthe Medical College Initial ofRegistrar Remarks practical training (Internship) attended 21 22 23 24 TheArunachal Pradesh Extraordinary Gazette, February 12, 2007 23 FORM-10 passport Affix recent size photograph (See Rule 41 (b)) Arunachal Pradesh Medical Council Nomination Paper Election to theArunachal Pradesh Medical Council (To be filled up by the Candidate) Bank DraftNo Date .
Amount ... ··············································· I am a registered practitioner of the Arunachal Pradesh Medical Council under Registration No , andherebyoffermy candidature for election as MemberofArunachal Pradesh Medical Council. I further declare that I shall work for Arunachal Pradesh Medical Council if elected.
I. Name of the Candidate (in block letters) (As it appears in the Arunachal Pradesh Medical Council Registration Certificate.)
2. Father's Name
3. Sex
4. Age
5. Present Occupation
6. Postal Address of the Candidate Date:
Signature of the Candidate ¢ (To be filled by the Proposer) I hereby propose Dr. as a candidate for the forthcoming election to the Arunachal Pradesh Medical Council.
I. Name of the Proposer (in block letters) (As it appears in the Arunachal Pradesh Medical Council Registration Certificate
2. Postal Address of the Proposer
3. Proposer's Registration No. in the Arunachal Pradesh Medical Council Signatureofthe Proposer (To be filled by the seconder) Date , .
.....
I second above nomination I. Name ofthe Seconder (in block letters) (As it appears in the Arunachal Pradesh Medical Council Registration Certificate.)
2. Postal Address of the Seconder
3. Seconder's Registration No. in the Arunachal Pradesh Medical Council Date , .. ,. Signature of the Seconder ············································ , .
(To be filled by the Returning Officer) Serial No. ofnomination paper ..
····················································································································· .
This nomination paper was delivered to me at my office on .
Date:- .
Decision ofReturning Officer Date .
(Returning Officer) (Returning Officer) INSTRUCTION
(i) Nomination papers which are not received by the Returning Officer before (hour) on the shall be rejected
(ii) The names of the proposer and seconder as they appear in the State Register ofArunachal Pradesh Medical Council and their registered number shall be clearly written below their respective signature.
Received the nomination paper.
(for office use only) Signature ofReturning Officer .
Name .
Date .
24 Sir/Madam, The Arunachal Pradesh Extraordinary Gazette, February 12, 2007 FORM-11 (SeeRule 41 (i) (iii)) Arunachal Pradesh Medical Council Letter oflntimation to the Voters Election to theArunachal Pradesh Medical Council I. The persons, whose names are printed on the voting paper sent herewith, have been duly nominated as candidates for the election to the Arunachal Pradesh Medical Council. If you desire to vote at the election, I request that you shall
(a) fill up and sign the declaration paper ;
(b) mark your vote/votes in the column provided for the purpose in the voting paper as directed on the voting paper;
(c) enclose the voting paper in the smaller cover (hereafter called the voting paper cover) and stick it up; and
(d) enclose the smaller cover and the declaration paper in outer envelope addressed to me and return the same to me by post or deliver it in person in my office so as to reach me not later than 2.00 P.M.
on the ofyear .
2. The votingpaper cover shall be rejected if-
(a) the outer envelope enclosing the voting paper cover is not sent by post or delivered in person in my office or is received later than the day and hour fixed for the closing of the poll ; or
(b) the outer envelope contains no declaration paper outside the voting paper cover; or
(c) the declaration paper is not the one sent by the Returning Officer to the voter ; or
(d) the declaration is not signed by the elector ; or
(e) the voting paper is placed outside the voting paper cover ; or
(f) more that one declaration or voting paper cover have been enclosed in one and the same outer envelope.
3. A voting paper shall be invalid, if;
(a) it does not bear the Returning Officer's initials or facsimile signature ; or
(b) the voter signs his name, or writes any word or makes any mark by which it becomes recognisable as his voting paper ; or
(c) no vote is recorded thereon ; or
(d) the number of votes recorded thereon exceeds the number of seats to be filled ; or
(e) there is uncertainty of the vote exercised.
4. If a voter inadvertently spoils a voting paper, he can return it, not later than seven days before the date appointed for the poll, to the Returning Officer who shall, if satisfied of such inadvertence, issue to him another voting paper.
5. The scrutiny and counting of votes shall begin on (date) at (Hour) at ............................. (Place).
6. No person shall be present at the time of scrutiny and counting of votes except the Returning Officer, such other persons as he may appoint to assist him and the candidate or their duly certified representative(s) under clause (k) ofRule 41 of the Arunachal Pradesh Medical Council Rules, 2006.
TheArunachal Pradesh Extraordinary Gazette, February 12, 2007 25 FORM-12 (SeeRule41 (@) (iii)) Arunachal Pradesh Medical Council Voter's Declaration Paper Election to theArunachal Pradesh Medical Council Election to theArunahcal Pradesh Medical Council under section 4 ofArunachal Pradesh Medical CouncilAct,2004(Act No. 4 of2004).
Serial No. . ..
Elector'sName .
Nwnber on the State }.
Register ofAllopath ELECTOR'S DECLARATION I (Namein full andDesignation ifany) declare that I am elector for the election to Arunachal Pradesh Medical Council by theelectorateunder section 4 of theAct and that I have signed no other voting paper at this election.
Station ..
State ..
Signature ..
FORM-13 (See Rule41() (iii)) Arunachal Pradesh Medical Council Voting paper Election to theArunachal Pradesh Medical Council SerialNo .
. .. . ._ ( in words member (s) is/areto be elected under section 4 oftheArunachal Pradesh Medical CouncilAct, 2004 (ActNo.4 of2004).
SI.No. Name andAddress of Candidate Vote I.
2.
3
4.
5.
6.
7.
Returning Officer Seal and Signature INSTRUCTIONS I. Each elector has number of votes as the number ofmembers to be elected.
2. Each elector shall give only one vote to any candidate.
3. Hel she shall vote by placing the Mark 'X' opposite the name of the candidate/ candidates to whom he wishes to vote.
4. The voting paper shall be invalid if-
(a) it does not bear the Returning Officer's initials or facsimile signature; or
(b) the voter signs his name or writes any word or makes any mark on it, by which it becomes recognisable as his voting paper; or
(c) no vote is recorded thereon; or
(d) the number of votes recorded thereon exceeds the nwnber of seats to be filled; or
(e) there is uncertainty of the vote exercised.
Number in words.
············•···········•············································· - 26 Place:
Date:
TheArunachal Pradesh Extraordinary Gazette, February 12, 2007 FORM- 14 (SeeRule41(@)&42 (vi)) Arunachal Pradesh Medical Council DECLARATION OF RESULT OF MEMBER, PRESIDENT & VICE-PRESIDENT Returning Officer.
FORM-15 (SeeRule42 (X)) Arunachal Pradesh Medical Council ELECTION OF PRESIDENT/VICE-PRESIDENT BALLOT PAPER i I hereby declare that Dr has been duly elected under subsection 1 (a) /2 / 3 ofsection4 oftheArunachal Pradesh Medical Council Act, 2004 (ActNo.4 of2004) as theMember/ President/ Vice-President of the Arunachal Pradesh Medical Council for a period of .........................................w.e.f. ..
SI.No. Name of the Candidates Vote Signature of the Returning Officer INSTRUCTIONS
5. Each elector has only one vote.
6. The elector should place the Mart(X) clearly opposite the name of the candidate of his choice.
■ • TheArunachal Pradesh Extraordinary Gazette, February 12, 2007 APPENDIX-C (See Rule 44) Arunachal Pradesh Medical Council 27 Declaration : Pledge At the time of registration, each applicant shall be given a copy of the following declaration by the Registrar and the applicant shall read and agree to abide by the same and affirmed by the signature in presence of Registrar.
(I) I solemnly pledge myself to consecrate my life to service of humanity .
(2) Even under threat, I will not use my medical knowledge contrary to the laws ofHumanity .
(3) I will maintain the utmost respect for human life from time of conception.
(4) I will not permit consideration ofreligion, nationality, race, party politics or social standing to intervene between my duty and my patient.
(5) I will practice my profession with conscience and dignity .
(6) The health ofmy patient will be my first consideration.
(7) I will respect the secrets which are confined in 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 tradition ofmedical profession.
( 10)1 will treat my colleagues with all respect and dignity .
( 11) I shall abide by the code ofmedical ethics as enunciated in the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulation, 2002.
( 12) I shall abide by the Rules ofArunachal Pradesh Medical Council, 2006 and shall uphold the motto ofArunachal PradeshMedical Council i.e, Service, Knowledge and Ethics in its correct prospective as enunciated in Rule 46 ofthe Arunachal Pradesh Medical Council Rules, 2006.
I make these promises solemnly, freely and upon my honour.
Signature .
Name .
Place .
Date .
Address .
Arunachal Govt. Press-43/2007-DIPR & P-25o+Secy (H&FW)-150-2-2007.