Online Registration Form
 
First Name
 
Family Name
 
Other Name Including Middle Name
 
Name Appearing On GMC letter
 
Date of birth
     
Sex
      Male         Female
Address Line 1
    
Address Line 2
    
City    
ZIP code    
State    
Country    
Telephone     Country code: - Area Code: -    Tel. number: - 
GMC number      
Email-1     How often do you check your emails?  
Email-2    
Client Manager    
Examination date     Plab1 :- Applied: -    
Check if same as applied for : Confirmed: -
  Plab2 :- Applied: -      
Check if same as applied for : Confirmed: -
Type of coaching      Only coaching (One week course)[80 + 190] pounds
   Partial (Two weeks course)[80 + 375] pounds
  Complete(Complete course with accommodation) [80 + 550 pounds]
Amount Sent      Please enter amount exactly as written on cheque/DD.
   Currency
Mode of Payment    Cash Cheque  Demand Draft
Cheque /DD No. 
Account No.:
Bank Name:-
Amount Sent By      Sent on :      
Documents attached      Passport copy
   GMC admission card copy
   Copy of degree certificate
   C V
   2 passport size photos
Documents Sent to  
India : 4, Neelkamal, Bhaskar Colony, Naupada, Thane - 400602, Maharashtra.
U K : 1st floor, 2A Burges Road, East Ham, London E6 2BH.
Courier Details    
Notes