To,

(Here mantiond the name and last known address of the medical
practitioner )

Sir,

In pursurance of clause (b) of sub-section (5) of section 16 of
The Gujarat Medical Council Act,1967, notice is hereby given that
you should pay to the undersigned a fee of five rupees in cash or by crossed postal order or by money order on or before** …………….
for the continunce on your name on the register under the said act.

If you fail to pay the fee within time stated above, your name shall be removed from the register as a defaulter.

Your name (in full) qualifications, Address, Registered No., Date of Registration should invariably be furnished in the money order coupen or in cash where paymant is made by crossed postal order , in forwarding letter.