KHYBER PAKHTUNKHWA
HEALTH CARE COMMISSION
Bungalow No. E-41, Jamal Uddin Afghani Road (Jam e Masjid Momin Khan Street),
University Town Peshawar. Web: www.kphra.gov.pk, Phone: 091-9216922
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REGISTRATION/ RENEWAL OF HOMEOPATHIC DOCTOR/ TABIB.
Fresh Registration: ______Renewal of Registration: ______
1. In case of renewal previous Reg. No. ______Valid up to: ______
2. Any change in the facilities or staff , address etc. from previous year registration:
______
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3. Name of Homeopathic Doctor/ Tabib: ______
4. Father name of Homeopathic Doctor/ Tabib: ______
5. CNIC No of Homeopathic Doctor/ Tabib: ______
6. Email ID of the Homeopathic Doctor/ Tabib: ______
7. Contact No. of the Homeopathic Doctor/ Tabib: ______
8. Postal Address of the residence of the Homeopathic Doctor/ Tabib:______
______
9. In Case of Government Job of the Homeopathic Doctor/ Tabib, details of designation and current place of posting:______
______
10. Professional Qualification details of the Homeopathic Doctor/ Tabib: ______
______
11. Council for Homeopathy/ Tibb Registration No.: ______Valid Upto: ______
12. Name of Health Care Facility: ______
13. Postal Address of Health Care Facility: ______
______Tehsil: ______Distt. ______
14. Telephone Contacts No’s of the Health Care Facility: ______
15. Name of Associated Medical Staff and their Professional Qualification (If any):
______
______
16. Details of Additional technical qualification in Health Profession (If any):
______
17. Duration: 1 year c , 2 year c , 3 year c , 4 year c , 5 year c
NOTE: REGISTRATION FEE SHOULD BE DEPOSITED IN THE FOLLOWING BANK
FEE CAN BE DEPOSITED ONLINE FROM ANY ALLIED BANK
Name of Bank: ALLIED BANK OF PAKISTAN PVT LTD
Branch Code: 0936 (Army Stadium Peshawar) Account No: 1585-2
Fee Deposited Amount (in figures) ______
(Amount in words)______
Bank Receipt No: ______date: ______
Name of the depositor (as per bank receipt): ______
Name of the ABL bank branch where fee deposited: ______
AFFIRMATION
The information provided is correct to the best of my knowledge and belief, I accept full responsibility for health care facility and shall ensure that all instructions issued by the Khyber Pakhtunkhwa Health Care Commission from time to time regarding health institutions shall be complied and proper documentation shall be maintained. I also undertake that in case of any lapse in compliance, I shall be liable to penalization under the Khyber Pakhtunkhwa Health Care Commission Act 2015 and rules and regulations made thereof.
Dated Signature of Homeopathic Doctor/ Tabib applicant: ______
FOR OFFICE USE ONLY
Token No.: ______Issue Date: ______Issued By: ______
I - FOR ACCOUNT SECTION OF HRA
(i) Verification of the bank receipt from bank statement:______
(ii) Name &dated Sign of the account section clerk:______
II - Applied Fresh or renewal of Registration: ______Checked by: ______
III - FOR REGISTRATION SECTION
Amount due (in figures) ______
Amount due (in words) ______
Amount Deposited (in Figures) ______
Amount Deposited (in words) ______
Difference in amount (Arrears):______
Details of difference in amount (Arrears): ______
Verification from PMDC website: ______
Registration Clerk Remarks, Name & signature: ______
ATTESTED COPIES OF THE FOLLOWING REQUIRED DOCUMENTS SHOULD BE ATTACHED TO THIS APPLICATION FORM
1. Professional Certificates 2. Two Passport size photographs 3. CNIC (photocopy) of Homeopathic Doctor/ Tabib 4. Sketch of the Health facility 5. Health facility Pad copy 6. Original Bank receipt
NOTE: ATTACH ADDITIONAL SHEET FOR DETAILS IF REQUIRED.
Annual Fee List Khyber Pakhtunkhwa Health Care Commission
Note -15% rebate on apply for two years registration will be admissible
-20% rebate on apply for 2-5 years registration will be admissible
No / Health Facility / Reg. Fee / Renewal Fee1 / Homeopathic Clinic / Rs.2,000 / Rs.2,000
2 / Homeopathic Clinic (Specialist) / Rs.5,000 / Rs.4,000
3 / Tibb (Hakim) Clinic / Rs.2,000 / Rs.1,500
4 / Tibb (Hakim) Clinic (Specialist) / Rs.4,000 / Rs.4,000
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