FORM - VII
(See Rule 53)
FORM OF APPLICATION FOR REGISTRATION AS DENTIST
(Under Section 34 and 35 of Dentists Act. 1948, Central Act. XVI of 1948)
To
The Registrar,
TELANGANA STATE DENTAL COUNCIL
Hyderabad – 500 095.
Sir,
I request you to register my name and address as a Dentist in Part ‘A’ of the Register of Dentists for the State of Telangana.
| Category | : | Bachelor of Dental Surgery (BDS) |
| Name in full (in block letters only) | : | Dr. BASANI PRAVALIKA REDDY |
| Gender | : | Female |
| Father’s Name | : | BASANI PRATHAP REDDY |
| Place, date & year of birth | : | Govt-hospital Malakpet , 10/01/1997 |
| Nationality | : | Natural born Indian Citizen |
| Residential address with pin code | : | 12-2-58/1c J.P nagar Bharath nagar Moosapet Hyderabad 500018 Landmark behind cooperative bank |
| Description of Qualification/s | : | Bachelor of dental surgery |
| Email ID | : | pravalikareddy400@gmail.com |
| Mobile No. | : | 9866790058 |
| Aadhaar Card No. | : | 5.50E+11 |
| Temperory Registration No | : | TR-607 |
| Amount | : | INR 2500.00 |
| Transaction ID | : | MOJO1310J05D76805891 |
| Date of Payment | : | 2021-03-10T09:59:52.151037Z |
DECLARATION BY THE APPLICANT: I Dr.
Dr. BASANI PRAVALIKA REDDY
here with declare that I am not registered with any other State Dental Council. I here by solemnly declare that I will abide by the "Code of Ethics - Registration for Dentists" prescribed by the Dental Council of India.