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U. P. DENTAL COUNCIL
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Student Registration Panel ( Permanent Registration - Other State Passout Only )
Candidate Details
*
Registration Part in Name
A
Title
--Select--
SRI.
SMT.
KM.
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First Name
Middle Name
Last Name
*
Father's Name
Gender
Male
Female
*
Mother's Name
*
Religion
--Select--
Hindu
Muslim
Sikh
Christian
NA
*
Permanent Address
*
Date Of Birth
*
Country
India
*
State
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*
District
--Select--
*
Pincode
*
Mobile No
*
Aadhaar No
*
Email-ID
Course Details
Note:- If your University/College is not present in the respected Dropdownlist then please contact with U. P. Dental Council or Send Email Full University/College name at updentalcouncil@upsmfac.org
*
Course
B.D.S.
*
University
--Select--
*
College
--Select--
*
Year of Joining
--Select Month--
January
February
March
April
May
June
July
August
September
October
November
December
*
Year Of Passing
--Select Month--
January
February
March
April
May
June
July
August
September
October
November
December
Enrollment No
Rotatory Internship Details
*
Internship Completion from same college
YES
NO
*
Hospital Name (I)
*
City
*
Joined Training On Date
*
Completed On
Hospital Name (II)
City
**Note: Fill the details in this Section if in case you are registered with any other Dental Council
Are you registered in any Other Council
YES
NO
Council
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Registration NO.
Date
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I here certify that the information furnished in this application is true to the best of my knowledge and belief. My Application/Registration may be rejected/cancelled, if any information provided herein is found to be incorrect or fake at any time during or after the submission of form. I understand that the U.P. DENTAL COUNCIL is not responsible for any inadvertent error that may have crept in the application being filled online over the internet.
मैं एतद्द्वारा प्रमाणित करता / करती हूँ की इस आवेदन में दी गयी समस्त जानकारी मेरे ज्ञान और विश्वाश के अनुसार सही है | किसी भी समय अगर गलत सूचना पायी जाती है तो मेरा आवेदन/रजिस्ट्रेशन निरस्त कर दिया जाये | मैं समझता / समझती हूँ की उ० प्र० डेंटल कौंसिल किसी भी अनजान त्रुटि के लिए जिम्मेदार नहीं है जो इंटरनेट पर ऑनलाइन भरे जाने वाले आवेदन में शामिल हो सकती हैं |
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ADD UNIVERSITY
PLEASE TYPE FULL UNIVERSITY NAME
(NOTE :- PLEASE TYPE FULL UNIVERSITY NAME CAREFULLY BECAUSE YOU CAN'T UPDATE UNIVERSITY NAME IN FUTURE. )
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ADD COLLEGE
UNIVERSTIY
--Select--
Note:- If your University is not present in the list then ADD UNIVERSITY first.
PLEASE TYPE FULL COLLEGE NAME
DISTRICT
(NOTE :- PLEASE TYPE FULL COLLEGE NAME CAREFULLY BECAUSE YOU CAN'T UPDATE COLLEGE NAME IN FUTURE. )
College Name - ABC, Lucknow
Rotatory College Name - ABC & Hospital, Lucknow
