odisha
 
APPLICATION FOR REGISTRATION UNDER DENTAL COUNCIL BHUBANESWAR ODISHA,
(FOR BDS / MDS / PG Diploma / PhD COURSES)
 
 
Please Fill up the Following Information to apply for Fresh Registration / Renewal of Registration/ Duplicate Registration / Additional Registration, Odisha
 
Please select the type of Application *(Fresh/Renewal/Reciprocal/Duplicate etc)
  
Please select the Course you have passed out *
Please enter the Name of Speciality (For MDS / Higher Qualification only)
 
Please select the Year of passing of the Course *
  
Please select the Name of the Institution from which you have passed out *
  
If select others ,please enter the institute name  
Enter SBI e-Pay / SBI Collect Reference No (DUXX)*
 
Enter SBI Bank Reference No (IGXXX)*
  
Please enter the Amount Paid (INR) *
  
Please enter the Date of Payment *
  

Enter your Full Name (As per 10th certificate) *

  
Enter your Father Name (As per 10th certificate)*
 
Enter your Mother's Name
 
Date of Birth (As per 10th certificate) *
    
Gender / Sex *
  
Please enter your Permanent  Address Details *
(At-Po-PS-Via-Dt-Pin)
 
Please enter your Valid Mobile No *
  
Please enter your valid e-mail ID *
  
Nationality and Citizen
  
Duration of the Course (From)/ Date of admission / Joining in the Training *
  
Professional Address
  
Enter your Adhar Number
 
Existing Registration Number Issued by Dental Council Odisha
(To be filled For Renewal / Additional /Duplicate / NOC Applications only )
 
Existing Registration Date
(To be filled For Renewal / Additional /Duplicate / NOC Applications only )
    
Existing Registration Validity Till
(To be filled For Renewal / Additional /Duplicate / NOC Applications only )
   
Name of the Examining Body / Board / University *
  
Date of declaration of the Result (As per certificate)
 
Upload your Signature *
(Scan Copy of Full SIgnature)
 
Upload your photo *
(Passport size colour photo in )
 
Upload Scan Copy
For Fresh / New Registration - internship completion certificate
For Other type Registration - Existing Registration Certificate
 
Upload Scan Copy
For Fresh / New Registration -Final BDS Passout Certificate
For other type Registration - BDS/MDS other Passout Certificate