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 ( U.P. Domicile Only )
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
Sorry you are not eligible, Domicile of U.P. must be required !!!
Candidate Details
Title
--Select--
SRI
SMT
KM
*
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
--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
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May
June
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*
Passing Year
--Select Month--
January
February
March
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May
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December
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January
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*
RollNo
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