Paramedical Council Registration Application

KERALA PARAMEDICAL COUNCIL
GOVERNMENT OF KERALA Paste a passport size

photograph of the
APPLICATION FOR REGISTRATION AS PARAMEDICAL PERSONNELS applicant and that has
to be attested
1. Name and Address of the Applicant with by a Gazetted
officer
district(In block letters as in SSLC) :
Phone No. with STD code

:
Mobile No. :
Email :
2. Address to which communications are to be sent :
3. Date of Birth in figures (in Christian era) :

4. Date of Birth in words :
5. Nationality :
6. Sex :
7. Father’s Name (in block letters) :
8. Nationality of Father :
9. Native Place of Father :
10. Official Address of the applicant :
11. Educational qualification

Name of
Sl thecourse Name& Address of the Period of Year of Percentage Name of University/Board under which the
No (from SSLC Institute/College study Pass of mark course was conducted
onwards)
1
7
12. Experience
Period of work Total experience

(Eg‐12/2/04 (eg‐1year&3 Name address of Head of institute
Sl.No Name of Hospital/ Institute/College to15/5/05) months) with phone/mob.No
13. State the category to which the registration

sought (See the instruction)
14. State the medium of instruction of training :

15. Details of remittance of registration fee
Transaction Reference Number/Journal Number/UTR Number:
(Enclose original counterfoil with transaction reference number noted on it)
Bank and Branch of Payment :
Date of Payment :
DECLARATION
I............................................................................................ (Name) hereby declare that the statement made in

the form are true to the best of my knowledge and belief and that I am free from the disqualification mentioned in the
sections of paramedical council bill/Act and promise in the event of my being registered and in consideration their of to
be bound by and to conform in all respects to the rules, regulations etc. framed by council from time to time in force.
Place : Signature
Date :
Name
I n s t r u c t i o ns
1. Registration will not be allowed if the degree/Diploma/certificate /course were issued from a
College/Institute /University not recognized by the paramedical council for which the registration
is sought.
2. For PMC Registration Certificates students should remit a fee of Rs.500 towards application fee
to the account of SECRETARY, PARAMEDICAL COUNCIL (ACC. NO: 57036990991; IFSC:
SBIN0070028) via NEFT/Direct Transfer. Original Counterfoil/Receipt clearly showing the
Transaction Reference Number (UTR Number/Journal Number) must be attached along with
the application. DEMAND DRAFTS WILL NOT BE ACCEPTED. Registration fee will not be
refunded at any reason.
3. Applicants who want to register as Health inspector shall submit their application before the
Principal, Government Public Health Training School, Vanchiyoor P O, Thiruvananthapuram
695035.
4. Applicants who want to register in the following categories shall submit their application before
the Director, Directorate of Medical Education, Medical College. P O, Thiruvananthapuram‐
695011.
i. Medical Laboratory Technician/Blood bank Technician
ii. Radiographer/X‐Ray technician
iii. Ophthalmic assistant/Optometrist
iv. Dialysis technician
v. Operation theatre Technician
vi. Neuro technician
vii. Physiotherapist
viii. Cardiac technician
ix. other courses approved by Paramedical council
5. No need of separate covering letter together with the application for registration.
6. Three recent and identical passport size color photographs are to be used. One should be
pasted on the space provided on the application form and that should be attested by a gazette
officer/Head of the Institution where the candidate is studying/has studied for the qualifying
examination. The other two copies of photograph (unattested) should be enclosed with the
application and his /her name and date of birth should be printed on its bottom.
7. The following documents should be enclosed with the duly filled application form in the order
below
i. Original Counterfoil of the transaction made to the account of Secretary Paramedical
Council with Transaction reference number correctly noted on it.
ii. Copy of the Government letter of permission for the recognition of the course in case
of private /self financing institutes
iii. Attested copy of SSLC or equivalent qualification to prove the date of birth.
iv. Attested copy of +2 mark list (both sides) or equivalent qualification.
v. Attested copy of qualifying technical /academic qualification (both sides) for which
registration is sought (2 copies).
vi. Attested copy of all additional qualification for which registration is sought (2 copies).

Paramedical Council Registration Application

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KERALA PARAMEDICAL COUNCIL

GOVERNMENT OF KERALA Paste a passport size

Phone No. with STD code

2. Address to which communications are to be sent :

3. Date of Birth in figures (in Christian era) :

11. Educational qualification

Period of work Total experience

13. State the category to which the registration

14. State the medium of instruction of training :

I............................................................................................ (Name) hereby declare that the statement made in

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