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FORM ''J''

Application for the continuation of the name on the Register under section
26 of the Bombay Homoeopathic Practitioner's Act, 1959
To,
The Registrar,
Maharashtra Council of Homoeopathy,
235, Peninsula House, 3rd Floor,
Dr. D.N. Rd., Above State Bank of Bikaner & Jaipur
Fort, Mumbai 400 001.

Subject :- Continuation of my Name on the Register


Sir,
1. I request that my name may be continued on the register of Homoeopathic
Practitioners maintained by the Council.

2. A fee of Rs. is paid to your office by D.D. only on ...................... as per


Instruction of column (5)

3. My Particulars are submitted below :-


(1) Full Name ...................................................................................................................
(Beginning with surname ion Block Capital)

(2) Maiden Name in Full ...................................................................................................


(Beginning with surname ion Block Capital)

(3) My Registration No. ....................................................................................................

(4) Date upto which it is renewed ............................................................................

(5) Qualification Possessed at the time of Registration .................................................

(6) Permanent address for correspondence .....................................................................

.....................................................................

Pin code .......................................................

Phone No. & STD Code (Res.)............................ (Clinic)...........................(Hosp)..................

(Mobile) ................................................................................

(E-Mail) ..............................................................................

Yours faithfully

Place : (Sign)
Date :- Full Name .......................................
INSTRUCTIONS
(1) This form must be returned duly completed with 4 passport size photographs so as
to reach the Registrar, Maharashtra Council of Homoeopathy, 236, Peninsula House,
Above State Bank of Bikaner & Jaipur, 3rd floor, Dadabhai Naoroji Road, Fort,
Mumbai 400 001 for continuation of name on the register before 6 months from last
date mentioned on Original registration cert.
(2) All Details should be correctly filled in.
(3) Information in clause 5 need not be filled by the practitioners registered on practice

basis.
(4) Application which do not contain the required particulars liable to be rejected.
(5) Fees for the continuation as under -
(a) Continuation fee Rs. 1500/- + Postage fee Rs. 100/-
(b) Late fee Rs. 2500/- (After due date mentioned on Original Registration Cert)
(c) Defaulter Fees Rs. 4100/- without I-card & Rs. 4400/- with I card.

(d) For new I card with Additional Qualification/Name Change/Address change are
requested to send Rs. 300/- Extra for I-Card

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