Pre-Conception and Pre-Natal Diagnostic Techniques

Name Of The Applicant

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Select District

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Sub Division

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Upload Applicant Photo

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(Allowed format JPG,PNG only)

Upload Applicant Sign

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(Allowed format JPG,PNG only)

Address

Applicant Email

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Applicant Mobile

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Apply Date

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Centre Name

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Centre Address

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Tick If Centre Name Is Same As Applicant Name

Tick If Centre Address Is Same As Applicant Address

Note: To add the doctor, fill all the details of the doctor like name, qualification, attachment and then click on the Save Doctor Details Button

Name

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Upload Photo (Allowed format JPG,PNG only)

Doctor Affidavit

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(Allowed format PDF only)

Upload Aadhaar/ ID

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(Allowed format PDF, JPG, PNG)

Upload Joining/ Offer of Appointment

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(Allowed format PDF, JPG, PNG)

Is PG Degree/Diploma endorsed from Delhi Medical Council (DMC) Yes No

Qualification

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Delhi Medical Council (DMC) Registration No.

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Delhi Medical Council (DMC) Certificate

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(Allowed format PDF only)

MBBS Degree
Yes No

Upload MBBS degree (Allowed format PDF only)

PG dgree/Diploma added in your DMC registration
Yes No

Delhi Medical Council (PG DMC) registration No

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Delhi Medical Council (PG DMC) certificate (Allowed format PDF only)

PG Degree/Diploma
Yes No

PG Degree/Diploma

PG Degree/Diploma (Allowed format PDF only)

PG Degree/Diploma in Radiology/UltraSonography/Image Scanning
Yes No

Additional Degree/Diploma

Additional Degree/Diploma (Allowed format PDF only)

Experience/Training in Radiology/UltraSonography/Image Scanning/Echocardiography
Yes No

Equipment Name

Machine No

Make

Model

Status

Machine Type

Additional Documents Upload

Please upload all the required supporting documents.

Upload Bank Statement of the Applicant/ Centre for the last six months. (Allowed format PDF only)

Upload layout plan of the premise... approved by local authority. (Allowed format PDF, JPG, PNG)

Upload Declaration, a part of Form-A in the form of Affidavit on Stamp paper.

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(Allowed format PDF only)

Upload Photographs of the Hospital/ Clinic/ Centre (signage, PNDT Board, Reception, etc.) (Allowed format PDF, JPG, PNG)

Upload Fire Safety Certificate. (Allowed format PDF, JPG, PNG)

Upload PWD accessibility document (chair lift/lift/elevator/basement). (Allowed format PDF, JPG, PNG)

Upload ART/ Surrogacy Clinic/ Bank certificate. (Allowed format PDF, JPG, PNG)

Upload MTP registration. (Allowed format PDF, JPG, PNG)

Upload Nursing Home registration. (Allowed format PDF, JPG, PNG)

Upload Affidavit in compliance to the Section 46 of the Persons with Disability Act, 1995 (Allowed format PDF only)

Company / Society Documents

Upload MoA/ AOA

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(Allowed format PDF only)

Upload Details of Board of Directors/ Share Holders (from MCA)

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(Allowed format PDF only)

Certificate of Incorporation (Companies Act, 2013)

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(Allowed format PDF only)

Certificate of Registration (Societies Registration Act)

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(Allowed format PDF only)

Invoice and Installation Report (all machines, one PDF)

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(Allowed format PDF only)

Preview Your Application

Please review all details carefully. Click 'Edit' on any section to make changes before proceeding to payment.

Basic Information

Applicant Name:
District / Sub Division:
Address:
Email / Mobile:
Centre Name:
Centre Address:
Applicant Photo:
Applicant Sign:

Additional Information

Type of Center:
Application Fee:: -
Multiple Facilities:
Type of Ownership:
Type of Institution:
Affidavit:
Facilities Available:
Tests Sought:

Doctor's Details

Equipment's Details

All Uploaded Documents

Review all documents uploaded across all steps. To re-upload, use the 'Edit' button to return to the relevant section.

Application Fee: -

Center Registration (Form A)

Note: To add the doctor, fill all the details of the doctor like name, qualification, attachment and then click on the Save Doctor Details Button

Additional Documents Upload

Company / Society Documents

Preview Your Application

Basic Information

Additional Information

Doctor's Details

Equipment's Details

All Uploaded Documents