THE TAMIL NADU Dr. M.G.R MEDICAL UNIVERSITY, CHENNAI - 600 032.
NOMINATION PAPER
To elect a representative of the Tamil Nadu Dr. M.G.R Medical
University, Chennai to the Dental Council of India, by the members of
the Senate, from amongst the members of the Dental Faculty of the
University under section 3 (d) of the Dentists Act, 1948.
.
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1. Name of the Candidate
:
2. Father's Name
:
3. Age
:
4. Nature of qualification and
Registration number.
:
5. Registration number in
the State Register
:
6. Address (Residential)
7. Name of the proposer
:
(should be member of the senate)
8. Registration number of Proposer in
the State Register
:
9. Signature of proposer
Address
:
:
Date :
10. Name of the Seconder
:
(should be member of the senate)
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11 Registration number of Seconder in
the State Register
:
12.
Signature of Seconder
:
Address
Date :
:
Declaration by the Candidate
I hereby declare that I agree to this nomination.
Signature of the Candidate.
CONSENT OF THE CANDIDATE
Election to the Dental Council of India
" I hereby declare that I am not a member of the above authority to which I
seek election and I agree to serve on the Dental Council of India if elected". I am a
member of the faculty of Dentistry and I am a teacher in a Dental College.
Signature of the candidate.
This nomination paper was received by me at ............ hour on the (date)
Returning Officer.
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INSTRUCTIONS
1. Nomination papers which are not received by the Returning Officer
before 4.00 p.m. on 02.12.2013 shall be rejected.
2. The names of the proposer and seconder, as they appear in the State
Register of Dental and their registered qualifications shall be
Clearly
written below their respective signature.