SSGMC - Upholding Medical Standards, Protecting Patients

SSGMC Reg. No (Obtained during registration-check your email)*:

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License type:

Citizenship*:

Nationality*:

Select Type of ID

ID No*:

Date of Birth:

Physical Address:

Town:

State:

Email:

Phone:

Registration Category:

Specialty:

Sub-Specialty:

Name of Authorized Premises*:

Physical Address:

Town:

State:

Type of Employment:

1. Photo

2. A copy of Reg. Certificate

3. Letter of No Objection from Employer (Schedule of duties for Part-time)

4. Work Permit

5. In case of New Premises, Inspection Report

6. Payment Slip

License application