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Application For SLMC Id Card

This document provides instructions for nominating another person to collect SLMC documents. The registrant must fill a nomination form with their and nominee's details. The nominee must present their SLMC ID at collection. SLMC is not responsible for documents after collection.

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anapayan.manoranjan
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759 views

Application For SLMC Id Card

This document provides instructions for nominating another person to collect SLMC documents. The registrant must fill a nomination form with their and nominee's details. The nominee must present their SLMC ID at collection. SLMC is not responsible for documents after collection.

Uploaded by

anapayan.manoranjan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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APPTICATION FOR A STMC ID CARD

PHOTO
DOCTORS (SLMC Copyl (PASSP0RT

PLEASE FILI IN B],OCK CA.PI TALS ( Use 01 cage for comma or dot. ) stzE)
SECTION:

rNrrALsANDrasrNAME,rExample: - A.A. SILVA / A.A. Silva x A.A.SArtu xl

STMC REG. NO:

euAlrFrcAroNs: [Exampr",. M B BS (CO tO M BO) / rrr, 1.o,.1, 1

ADDRESS
txample
Line0l
N001,
AI!!ANDA,
line02
SANKAPATA
ROAD,
Line03
PILIYANDALA,

tine04
HORANA.

NIC NO:

[Example: 8S809s132 V I

SIGNATUREI

DATE

CONTACT NO Please write in SLMC copy


SLMC ldetrtity C d

INSTRUC'TIONS

Please forrvard the following: [Plse!p-Ellj!-B!99t!gpi&b

l. Bolh applic.tions on the reverse duly completed and signed by the applicant.

2. The Original I.iational Identity Card and one photocopy ofthe saoe.

760
S.Thefeefor'IdetrtityCard'isRs.590/-,whichshouldbeoeditedtotheAccountoftheSriLatrksMedic.lCouncil-
AJa Nll fxIm?l2m fRrnk nfc.vlon- .Please ensure whether your MC No and rcleyart payment
category (ID)werc entered by the Banking Oflicer for tuhre clarifications. The Bant Credit Slip (C,reen) should be
attache-d rrith the application

4. Trro (2) recent ColourEd PossportSize Photographs. One should be pasted onthe top right-hand sideofthe
application

5. tfyou have lost the SLMC ldentity Card that you have al-ready obtained before, please submil a Police -Entry
Report to the effect that your SLMC Identity Card has been lost.

6. Ifyou are applying foran SLMC ldentity Card due to damage ofthe previous card, you should retum the old
card when you collect the new ldentity Card.

The Idetrtity C.rd usually ? tlkes about 2 to 3 motrths' tiDe, you will b€ itrformed by letter or by telephone when
the c.d is ready.
APPLICATION FOR A SLMC ID CARD PHOTO
DOCTORS (PASSP0RT

PLEASE FI],I IN BI,OCK CAPITALS (Use 01 cagE for coruna o. do!. )


srzE)
SECIION:

TNTTaLSANDLASTNAwTE: tEXamplg: - A.A. SILVA / A.A.Sdtva, xl

sLMC REG. NO:

QUALIFIcATIoNS: lExamplel MBBS (COLOMBO)/ MsBs (coL) x I

I
2

AODRES5 Erample
Line01

Line02
ll No 01,

SANKAPALA
-.,1

ROAD,
Line03 PItIYANDAI"A,
I

Llne04 HORANA.
L -Lr I

NIC NO:
Tt-t T-fTt]-rftTl lExarnple: 858095132 V l

SIGNATUREi

DATE

CONTACT NO Please write in SLIV1C coPi


Sri
Lanka Nominating a Person to Collect Documents
Medical
Council
Only SLMC registrants having an SLMC ID card can be nominated to collect certificates and ID
cards on behalf of the registrants.

Registrant’s details
Category:
Registration No.:
Name:

Nominated person’s details


Category:
Registration No.:
Name:

Description of documents to be collected


1.
2.
3.
I am authorizing the above-nominated person to collect the above documents on my behalf. I know
Sri Lanka Medical Council will not be responsible for any loss or damage of documents after collection
from SLMC.

Signature of the proposer Signature of the nominee


Date:

Please attach the nominated person’s photocopy of the SLMC ID card. No document will be issued
without the SLMC ID of the nominee.

To be completed at the time of collecting documents from SLMC

I have received the undamaged documents listed above and will be handing them to the proposer as
soon as possible.

Signature of the nominee Initials of the SLMC staff


Date
Instructions
• The Sri Lanka Medical Council advises the registrants to collect their documents from the SLMC
Offie.

• Under exceptional circumstances, the registrants may nominate an SLMC registered person to
collect their documents on their behalf by furnishing this nomination form.

• The SLMC is not responsible for lost or damaged documents once dispatched or handed over.

• The SLMC will not replace lost or damaged documents.

The SLMC would issue duplicates or extracts of lost or damaged documents, whichever is
•
applicable.

Registrar
Sri Lanka Medical Council
31 Norris Canal Road
Colombo 10
Website: www.slmc.gov.lk
Email: [email protected]
Telephone: +94112691848
Fax: +94112674787

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