22. Particulars of the Registration fee paid (D.D No., Name f the Bank, and Date)

(Signature)
(Name and Designation and full address with official seal.)
Form II
Form II
( See rule 4 (d))
Acknowledgement
* The list of enclosures attached to the application in Form I has been verified with the enclosures submitted and found to be correct.
Or
*On verification it is found that the following documents mentioned in the list of enclosures are not actually enclosed.
i.
ii.
iiii.
iv.
v.
(..............................)
Signature and Designation of Registration Authority, or authorized person in the Office of the Appropriate Authority.
Seal
Form III
Form III
( See Rule 4 (F))
Government of Andhra Pradesh
Health Medical and Family Welfare Department
District Registering Authority
Certificate of Temporary Registration of Allopathic Private Medical Care Establishments
(Valid for 90 days from the date of issue)
i..............................:.........
ii.......................................
Signature of the
(Office seal)
Form IV
Form IV
( See Rule 5 (A))
Government of Andhra Pradesh Health Medical and Family Welfare Department
District Registering Authority
Certificate of Registration of Allopathic Private Medical Care Establishments
i. - - -----------
ii.-------------
Signature and name of the District Registering Authority
.................District
(Office seal)
Form - V
Form - V
( See Rule 5 (C))
Government of Andhra Pradesh
Health Medical and Family Welfare Department
District Registering Authority.........................
................................... Rejection of Application For Grant/renewal of Registration Reference Number and Date:
Rejection of Application For Grant/renewal of Registration
Reference Number and Date:
(1) Name and address of the Allopathic Private Medical Care
Establishment
(2) Reasons for rejection of application for grant / renewal of
registration
Signature, name and designation of the Registration Authority with office seal.
* Strike out whichever is not applicable or necessary
Form - VI
Form - VI
( See Rule-6)
Application for Renewal of Certificate of Registration
Application for Renewal of Certificate of Registration
The Registering Authority
(1) Date of issue of Certificate of Registration to be renewed (enclosed the original Certificate in duplicate)
(2) Date of Expiry of Certificate of Registration to be renewed.
(3) File number of the Registering Authority
(4) Particulars of Renewal fee paid (D.D.No., Name of the Bank, and date) (Original D.D. enclosed)
(5) I hereby declare that the contents mentioned in this application are true and correct to the best of the my knowledge
(Signature)
(Name, Designation and full address with office seal.)
Form VII
Form VII
( See Rale 6)
Government of Andhra Pradesh
Health Medical and Family Welfare Department
District Registering Authority
...........................
Certificate of Renewal of Registration of Allopathic Private Medical Care Establishments
M/s-----------------located at----------------is hereby renewed under the provisions of A.P. Allopathic Private Medical Care Establishments Registration and Regulation) Act, 2002. to provide following medical care services:
i.----------------
ii. --------------
Signature and Name of the District Registering Authority
(Office deal)
Form - VIII
Form - VIII
( See Rule 7(b)
Government of Andhra Pradesh
Health Medical and Family Welfare Department
District Registering Authority
Notice
M/s--------------
Or
Signature and name of the District Registering Authority
(Office seal)
Form IX
Form IX
( See Rule 7 (d))
Government of Andhra Pradesh
Health Medical and Family Welfare Department
District Registering Authority
Order
(1) Reference Number and Date:-------------
(2) Registered notice number and date-------------------
(3) File Number of Registering Authority-------------
(4) Date of hearing---------------------
(5) Whether Establishment has submitted answer in writing................................. Yes/No
(6) If so, what are the contents and documentary evidence produced by the Applicant-Establishment
(7) Are they satisfactory.........................Yes/No
(8) Additional document (s) submitted by the Complaint, if any------------
(9) Are they relevant to case.........................Yes/No
(10) Point(s) for consideration in the case------------
(11) Findings of the District Registering Authority-------
Or
Signature and name of the District Registering Authority
(Office seal)
Form-X
Form-X
( See Rule 8(b))
Application for Filing an Appeal Against the Orders of Registration Authority
Chairman.
Appellate Board and Principal Secretary to Government,
Health, Medical and Family Welfare Department.
A.P. Secretariat Hyderabad-22
Appeal filed under Section 10 (1) of the A.P. Private Medical Care Establishment (R and R) Act, 2002