U.P. Medical Council
5, Sarvpalli Mall Avenue Road, Lucknow - 226001 (U.P.) India
Call -
(0522) 2238846, 2235964, 2235965, 3302100
Email-Id -
upmedicalcouncil@upsmfac.org
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M.B.B.S. Foreign Provisional Registration Panel
Have you qualified the screening test conducted by N.B.E. (National Board of Examination) ?
YES
NO
Sorry you are not eligible, Screening Test must be Qualified to Fill this Form !!!
Do you have a domicile of U. P. ?
YES
NO
Have you completed your course online.. ?
YES
NO
Sorry you are not eligible to apply in U.P. portal...Please apply in "OnlineForeignProvisionalOUP"!!!
Candidate Details
Title
--Select--
SRI
SMT
KM
Resident
Internship Duration
*
First Name
Middle Name
Last Name
Gender
Male
Female
Father's Name
*
--Select--
SRI
Mother's Name
*
--Select--
SMT
*
Date Of Birth
*
Religion
--Select--
Hindu
Muslim
Sikh
Christian
NA
*
Address
*
Country
INDIA
*
State
Uttar Pradesh
--Select--
*
City
--Select--
*
Pincode
*
Contact No
*
Aadhaar No
*
Email-ID
Course Details
*
Course
M.B.B.S.
*
University
--Select--
*
Center
--Select--
Year of Joining
*
--Select Month--
January
February
March
April
May
June
July
August
September
October
November
December
*
Passing Year
--Select Month--
January
February
March
April
May
June
July
August
September
October
November
December
--Select Month--
January
February
March
April
May
June
July
August
September
October
November
December
*
NBE RollNo
*
NBE Result Year (As per the passing certificate issued by NBE, N.Delhi)
--Select Month--
January
February
March
April
May
June
July
August
September
October
November
December
*
ELIGIBILITY CERTIFICATE No.(MCI/NMC)
*
NBE Marks
*
Name of Passing Class 10 Board
*
Name of Passing Class 12 Board
*
Passport Number
Already completed First One Year of Internship in India ?
YES
NO
Rotatory Training College Details
*
Traning Hospital 1
Hospital
*
City
*
Joining Date
*
Completed On
*
Internship
Completion Mode
--SELECT--
ONLINE
OFFLINE
MIXED
Traning Hospital 2
Hospital
City
Traning Hospital 3
Hospital
City
Council
--Select--
Council Provisional Registration NO.
Provisional Registration Date
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