Maharashtra State OTPT Council, Mumbai.
St. George's Campus Hospital, Behind C.S.T. Mumbai - 400001 Ph. 22620408
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Form-VIII
(fu;e 61 )
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(See rule 61)
Affix your passport size photograph
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Form of Application for Renewal of Registration
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ifj"kn] eqacbZ*----------------------------------To, The Registrar, Maharashtra Council for Occupational Therapy and Physiotherapy, Mumbai *-----------------------------------
1367
Hkkx pkj& c A egkjk"V! 'kklu jkti_k] vlk-]l"Vsacj 14]2007$Hkknz 23]'kds 1929
egksn;$ Sir, eh ek>;k uksan.khps uohdj.k dj.;kph vkiY;kyk fouarh djhr vkgs-ek>ks uko o brj ri'khy [kkyh uewn dsyk vkgs I Request you to renew my registration. My name and other particulars are stated below :‐ laiw.kZ uko % Name of full : (BGd v{kjkr vkMukokus lqjQokr
djQu 'ksoVh ofMykaps$irhps uko fygkos) (Beginning with surname, and including Father's/Husband's name in block letters only) iRrk %
Address : fookfgr L_khps ckcRkhr R;k L_khps
fookgkiwohZps uko o vkMuko
Maiden name and surname in the case of married woman : (BGd v{kjkr vkMukokus lqjQokr djkoh)
(Beginning with surname in Block Letters) Hkkx pkj& c A egkjk"V! 'kklu jkti_k] vlk-]l"Vsacj 14]2007$Hkknz 23]'kds 1929
1368 jk"Vh!;Ro % Nationality : tUefnukad % Date of Birth : vgZrZps o.kZu % Description of qualifications : fo|kihBkps fdaok laLFksps uko %
The name of the University or Institution : uksan.kh dzekad o uksanoghpk Hkkx % Registration No. and Part of Register : uksan.khpk fnukad %
Date of Registration : jQ- 1500$& (jQi;s ,d gtkj ikp'ks iQDr) ,o<h uohdj.k iQh n'kZuh
/kukd"kkZ}kjs ikBohr vkgs- The renewal fee of Rs. 1500/‐ (Rupees One Thousand five hundred only) is sent by Demand Draft only. 1367
Hkkx pkj& c A egkjk"V! 'kklu jkti_k] vlk-]l"Vsacj 14]2007$Hkknz 23]'kds 1929
ek>ks uksan.kh izek.ki_k vkf.k vksG[ki_k ;klkscr ikBohr vkgs-eyk 'kD; rso<;k yodj ,d uohu uksan.kh izek.ki_k o uohu vksG[ki_k ns.;kph eh vki.kkal foaurh
djrks $ djrs- My Registration Certificate and identity Card are sent herewith. I request you to issue me a fresh Registration Certificate and fresh Identity Card as early as possible. vkiyk fo'oklw] Yours faithfully. fnukad % Date : (lgh) (Signature) Hkkx pkj& c A egkjk"V! 'kklu jkti_k] vlk-]l"Vsacj 14]2007$Hkknz 23]'kds 1929
1368 lwpuk-& Instructions (1) vtkZrhy loZ ri'khy iQDr vtZnkjkusp Hkjkok 1) All particulars in the application shall be filled by the applicant only. (2) loZ ri'khy O;ofLFkr o lqokPp v{kjkr vlkok 2) All particulars should be correctly filled in a neat and legible hand. (3) uksan.khps uohdj.k dj.;kph iQh n'kZuh /kukd"kkZ}kjs ikBokoh 3) The free for renewal of registration should be sent by Demand Draft in favour of Registrar, Maharashtra State OT/PT Council,Mumbai. (4) ikliksVZ vkdkjkrhy Nk;kfp_k vtkZP;k mtO;k dksi`;kr fnysY;k tkxh
ykokos 4) The latest photograph should be affixed at place provided in right corner of the application.