1.
Nepal Medical Council
Bansbari, Kathmandu
Tel : +0977-01-4377164/4371954
Application for Registration Status (Certificate of Goodstanding)
Name:_____________________________________________________________________
Date of birth : (AD) Year ______ Month ____ Day ___ (BS) Year ______ Month ____ Day ___
Sex : Male Female NMC registration No. : _________ Mobile No. _________________
Email address :_____________________________________________________________
Date of temporary registration (AD) Year ______ Month ____ Day ___
Date of permanent registration (AD) Year ______ Month ____ Day ___
Highest academic qualification: _____________________ Specialty ___________________
Current employer : __________________________________________ Since ___________
Reason for application : _______________________________________________________
Organization intended to submit registration status :________________________________
Undergraduate study scholarship or bond : Yes No If Yes, release letter.
Postgraduate study scholarship or bond : Yes No If yes, release letter.
Applicant's signature : __________________ Date : _______________
Checklist for application :
1) Duly filled application form 2) Photocopy of Temporary/Permanent/Specialist registration
3) Bank voucher/eBanking of Rs. 1,000 for Nepalese & Rs. 2,000 for Foreigner. Nepal SBI Bank
Account Name Nepal Medical Council, A/C No. 2043 5240 1000 22 OR Rastriya Banijya Bank
Account Name Nepal Medical Council, A/C No. 1150 1000 0233 1001
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