PMDC Form IV
PMDC Form IV
PMDC Form IV
PM&DC Registration Number -Please paste one Photograph and then get it attested by the person specified overleaf as in instruction 4
The Registrar Pakistan Medical & Dental Council G-10-/4, Mauve Area, Islamabad. Subject:
Dear Sir,
RECOGNITION OF EXPERIENCE
I am enclosing experience certificates (instructions overleaf) as per details given below for recognition. Please issue me experience certificate for (mention purpose, e.g. fresh appointment/promotion etc.) ___________________________________________________________________ Detail of experience Duration ( mention dates) From------------------------to
Sr. No.
Designation
Sr. No.
Details of original articles/publications (attach only those articles, where authorship is among 1st three authors)
General information
a. The experience certificate is being issued on the basis of experience as communicated by the Principal/Dean/Head of your teaching institution, and shall be modified on the Dean/Principal/ Head of Institution's request. b. The experience certificate(s) enclosed with this form for recognition must contain the details of nature and title of job and period of job (day, month and year) including your name. c. If you are in service applicant, please route your application through proper channel. d. Be fully aware of the fact that the experience certificate is accepted/processed and issued in accordance with PM&DC rules. e. Incomplete applications shall not be accepted and returned in original. f. Fee shall be remitted with every submission.
Foreign Experience:
a. This form (per-page) duly filled-in and signed by the doctor. b. Photostat copy of valid registration certificate under which basic as well as postgraduate qualifications are registered with this Council. c. Four Photostat copies of each experience certificate (signed by the Head of Institute) duly attested by the Principal of any Medical/Dental College in Pakistan OR by an authorized Officer of Pakistan Embassy in that Country OR by an authorized Officer of the Ministry of Foreign Affairs in Pakistan. d.. Two passport size photographs duly attested by the person specified above. e. Experience certificate fee of Rs. 1500/- through Bank Draft/Pay Order in Favour of Pakistan Medical and Dental Council, Islamabad. f.. Processing fee Rs.5000/- (non-refundable) through Bank Draft/Pay Order in favour of Pakistan Medical & Dental Council, Islamabad. g. An Affidavit on Rs.10./- Stamp Paper (specimen No 1) h. Please fill out the release of liability form.
d.
Publications/Articles
Please provide original journal(s) in which article(s) have been published OR one copy of each article and front page of the Journal, duly attested by a professor of a recognized medical/dental college. Please provide only those Original Articles, in which you are among first three authors. Please note that Thesis/ Dissertation, Review Articles, Case Reports etc. do not have any credit.
SPECIMEN NO.1 OF AFFIDAVIT ON STAMP PAPER OF RS.10/For Issuance of Experience Certificate I, Dr. _____________________________________________________________________________________________
S/O,D/O ____________________________________________ Regn. No__________________ Resident of ____________________________________________________________________ do hereby solemnly affirm as under:1. I am submitting my documents to the Pakistan Medical & Dental Council for the issuance
of the experience certificates for the purpose ______________________________________ 2. I am fully aware that more than one agency is involved in such process and considerable time is consumed and I shall not pressurize or demand for any hurry. 3. I am submitting these documents purely on my risk and risk and responsibility and I will not hold PM&DC responsible for delay etc. 4. 5. will totally accept the decision of the Council and shall not challenge it in any form. I am fully aware that submitting this application is in my own interest and shall wait till
PM&DC responds patiently. 6. The above facts are true to the best of my knowledge.
Deponent
I, Dr. ________________________________________________________________________________________
S/O,D/O __________________________________________ Regn. No____________________ Resident of ____________________________________________________________________ do hereby solemnly affirm as under:1. 2. A copy of experience certificate No.______________________ was issued to me which has been submitted to __________________________ / mis-placed by me I require another copy of certificate for the purpose __________________________ _____________________________________________________________________ 3. 4. I am not concealing the facts and will not misuse the experience certificate. The above facts are true to the best of my knowledge.
Deponent
Dear Dr, Please ensure 1. You have filled in the PM&DC Proforma for recognition of experience completely. 2. You have attached required copies of teaching experience certificate duly issued by the principal/dean of the concerned teaching medical/dental institution where you have served. 3. You have attached two latest passport size photogra 4. You have attached one attested copy of each original article.(if applicable) 5. You have routed your application through your principal/dean if you are in service applicant. 6. You have got your experience certificates issued by medical Yes No
Dated: _____________________