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Registration No _____________
This is to certify that * Shri / Shrimati / Kumari_________________________________
* Strike off the alternative not required.
Of ______________ Possessing the qualifications of ____________ having passed the examination of has been given provisional registration under the Gujarat Medical Council Act, 1967 in Part IV of the register for the purpose of ** ___________
In witness whereof are herewith affixed the seal of the Gujarat Medical Council, and the signature of the Registrar.
Subject to the provisions of the said Act, this certificate is valid upto ?__________
Dated the
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