044-23638476
tndcsmartidboard@gmail.com
ID CARD & SMART NAME BOARD
*
indicates mandatory fields
REGISTRATION DETAILS
TNDC Registration No.& Date
*
Name (As in TNDC Registration Certificate)
*
Name in Tamil
*
(Switch
Tamil Keyboard
If You apply in
Mobile
)
Qualification
*
Select
B.D.S.,
M.D.S.,
Speciality
*
Select
COMMUNITY DENTISTRY
CONSERVATIVE DENTISTRY
CONSERVATIVE DENTISTRY AND ENDODONTICS
OPERATIVE DENTISTRY
ORAL AND MAXILLOFACIAL PATHOLOGY AND ORAL MICROBIOLOGY
ORAL AND MAXILLOFACIAL SURGERY
ORAL MEDICINE
ORAL MEDICINE AND RADIOLOGY
ORAL PATHOLOGY
ORAL PATHOLOGY AND MICROBIOLOGY
ORAL PATHOLOGY, MICROBIOLOGY AND FORENSIC ODONTOLOGY
ORAL SURGERY
ORTHODONTIA
ORTHODONTICS
ORTHODONTICS AND DENTOFACIAL ORTHOPAEDICS
PAEDODONTICS AND PREVENTIVE DENTISTRY
PAEDIATRIC AND PREVENTIVE DENTISTRY
PAEDIATRIC DENTISTRY
PEDIATRICS AND PREVENTIVE DENTISTRY
PEDODONTIA
PEDODONTIA AND PREVENTIVE DENTISTRY
PEDODONTICS
PEDODONTICS AND PREVENTIVE DENTISTRY
PERIODONTIA
PERIODONTICS
PERIODONTOLOGY
PROSTHETIC DENTISTRY
PROSTHODONTICS
PROSTHODONTICS AND CROWN AND BRIDGE
PUBLIC HEALTH DENTISTRY
.
Date Of Birth
*
Residential Address (TamilNadu only)(Must be match with the id proof)
*
Pincode
*
Mobile Number
*
Email ID
*
ATTACHMENTS
Note:
upload only
jpg, jpeg
and
pdf
format and less than 5MB
Photo (Allowed image format 'jpg' and 'jpeg' )
*
TNDC Registration Certificate
*
ID Proof (Aadhaar/Voter ID)
*
Transfer Certificate/Pan Card
*
Payment Transaction Proof
*
PAYMENT DETAILS
Bank Details
Payment Rs.
*
Payment Dt.
*
Payment Mode
*
Select
IMPS
NEFT
RTGS
GOOGLE PAY
PHONEPE
UTR
NERT
Transaction Ref No
*
Bank Name
*
Branch
*
INSTRUCTIONS:
Both Id card and Smart Name Board Will be delivered to the Above Mentioned residential Address.
The ID Card and Smart Board will be issued within a month from the Date of Receipt.
Payment not Refundable.
Submit
Thanks for Submitting...
BANK DETAILS...
BANK NAME :
State Bank of India
BRANCH:
Koyambedu
ACCOUNT NO:
35204707928
IFSC CODE NO:
SBIN0009675
NAME :
Tamil Nadu Dental Council
tndcsmartidboard@gmail.com