ALLIED HEALTHCARE PROFESSIONALS REGISTRATION AUTHORITY

APPLY FOR ACKNOWLEDGEMENT

AS ALLIED HEALTHCARE PROFESSIONALS REGISTRATION AUTHORITY PROFESSIONAL

(ALL FIELDS ARE MANDATORY)

Name Of The Candidate

Father's Name

Mother's Name

DATE OF BIRTH

Address

Post Office

Police Station

BLOCK / MUNICIPALITY

SUB-DIVISION

District

State

Pincode

Contact Details

Mobile Number

Educational Qualification

SL	EXAM	EXAMINATION AUTHORITY	YEAR	%	REMARKS
1	10th	* MUST BE REQUIRED	* MUST BE REQUIRED	* MUST BE REQUIRED	* MUST BE REQUIRED
2	12th	* MUST BE REQUIRED	* MUST BE REQUIRED	* MUST BE REQUIRED	* MUST BE REQUIRED
3	HIGHEST EDUCATIONAL QUALIFICATION	* MUST BE REQUIRED	* MUST BE REQUIRED	* MUST BE REQUIRED	* MUST BE REQUIRED
4	MEDICAL DIPLOMA
5	MEDICAL DEGREE

MEDICAL COLLEGE / MEDICAL INSTITUTE NAME

Postal Address

VILLAGE / WORD

Post Office

BLOCK / MUNICIPALITY

Police Station

SUB-DIVISION

District

State

Pincode

Upload Documents

10th

12th

Medical Degree / Medical Diploma

Medical Final Marksheet

Aadhar Card

Photo

HIGHEST EDUCATIONAL QUALIFICATION

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