[Cites 0, Cited by 0]
[Entire Act]
State of West Bengal - Section
Section 21 in West Bengal Yoga and Naturopathic System of Medicine Rules, 2015
21. Election of the Council.
- The election of the council shall be held in the manners as specified in the rules regarding election framed under the Paschim Banga Ayurvedic System of Medicine Act, 1961 (West Ben. Act XIII of 1961) issued vide no. MED/3805/IA-76/66 dated Calcutta the 17th June 1966 under the Department of Health, medical branch.Form - IApplication for Class 'A' Registration for an Institutionally qualified Yoga and Naturopathy Practitioner[See Rule 9(1)]| 1. | Name | : |
| 2. | Name of father/husband | : |
| 3. | Permanent address with PIN code | : |
| 4. | Present address with PIN code | : |
| 5. | Mobile no. | : |
| 6. | E-mail address, if any | : |
| 7. | Date of birth | : |
| 8. | Details of educational qualification | : |
| Qualifications | Name of the Course | Year of passing | Name of Board/University | % of marks obtained | Remarks, If any |
| Madhyamik/ 10th standard | |||||
| 12th standard | |||||
| Degree /Diploma in Yoga and Naturopathy | |||||
| Any other qualifications |
| 9. | Details of experience; if any | : |
| Declaration : | ||
| I hereby declare that all the above informationare correct to the best of my knowledge and belief. In case any of theinformation is subsequently found to be incorrect, I accept that myapplication will be rejected and that action as warranted under thelaw may be initiated against me.I have enclosed photocopies of documentsin respect of the information given above. |
| 1. | Name | : |
| 2. | Name of father/husband | : |
| 3. | Permanent address with PIN code | : |
| 4. | Present address with PIN code | : |
| 5. | Mobile no. | : |
| 6. | E-mail address, if any | : |
| 7. | Age and Date of birth | : |
| 8. | Details of educational qualification | : |
| Qualifications | Name of the Course | Year of passing | Name of Board/University | % of marks obtained | Remarks, If any |
| Degree | |||||
| Any other qualifications including Sports/Yoga |
| 9. | Details of Professional experience | : |
| 10. | Total experience of Practice in Yoga and Naturopathy | : |
| 11. | Whether practicing in private capacity | : |
| 12. | If yes, status of premises (rented/own) | : |
| 13. | Whether employed in a Hospital or Clinic or Institution | : |
| 14. | If yes, name and full address | : |
| Declaration : | ||
| I hereby declare that all the above informationare correct and true to my knowledge and belief. In case any of theinformation is subsequently found to be incorrect, I accept that myapplication will be rejected and that action as warranted under thelaw may be initiated against me.I have enclosed photocopies of documentsin respect of the information given above. |
| 1. | Name | : |
| 2. | Name of father/husband | : |
| 3. | Permanent address with PIN code | : |
| 4. | Present address with PIN code | : |
| 5. | Mobile no. | : |
| 6. | Date of birth | : |
| 7. | E-mail address, if any | : |
| 8. | Details of educational qualification | : |
| Qualifications | Name of the Course | Year of passing | Name of Board/University | % of marks obtained | Remarks, If any |
| Madhyamik/10th Standard | |||||
| 12th Standard | |||||
| Any other qualifications |
| 9. | Details of Professional experience | : |
| 10. | During of Practice in Yoga and Naturopathy | : |
| 11. | Whether practicing in privately | : |
| 12. | If yes, status of premises (rented/own) | : |
| 13. | Whether employed in a Hospital or Clinic | : |
| 14. | If yes, name and full address | : |
| Declaration : | ||
| I hereby declare that all the above informationare correct and true to my knowledge and belief In case any of theinformation is subsequently found to be incorrect, I accept that myapplication will be rejected and that action as warranted under thelaw may be initiated against me.I have enclosed photocopies of documentsin respect of the information given above. |
| 1. | Name | : |
| 2. | Name of father/husband | : |
| 3. | Permanent address with PIN code | : |
| 4. | Present address with PIN code | : |
| 5. | Mobile no. | : |
| 6. | Date of birth | : |
| 7. | E-mail address, if any | : |
| 8. | Details of educational qualification | : |
| Qualifications | Name of the Course | Year of passing | Name of Board/University | % of marks obtained | Remarks, If any |
| Madhyamik/ 10th standard | |||||
| 12th standard | |||||
| Diploma in Yoga and Naturopathy | |||||
| Any other qualifications |
| 9. | Details of professional experience, if any | : |
| Declaration : | ||
| I hereby declare that all the above information arecorrect and true to my knowledge and belief. In case any of theinformation is subsequently found to be incorrect, I accept that myapplication will be rejected and that action as warranted under thelaw may be initiated against me.I have enclosed photocopies of documentsin respect of the information given above. |
| 1. | Name | : |
| 2. | Name of father/husband | : |
| 3. | Permanent address with PIN code | : |
| 4. | Present address with PIN code | : |
| 5. | Mobile no. | : |
| 6. | Date of birth | : |
| 7. | E-mail address, if any | : |
| 8. | Details of educational qualification | : |
| Qualifications | Name of the Course | Year of passing | Name of Board/University | % of marks obtained | Remarks, If any |
| Madhyamik/ 10th standard | |||||
| One year Certificate in Yoga and Naturopathy | |||||
| Any other qualifications |
| 9. | Details of professional experience | : |
| Declaration : | ||
| I hereby declare that all the above information arecorrect and true to my knowledge and belief. In case any of theinformation is subsequently found to be incorrect, I accept that myapplication will be rejected mid that action as warranted under thelaw may be initiated against me.I have enclosed photocopies of documentsin respect of the information given above. |
| SI. No. | Registration No. | Date of Registration | Name | Qualifications and dates thereof | Class of Registration Class A/ Class B | Date & Reasons of removal Date, section ofthe Act under which the name has been removed | Remarks |
| (1) | (2) | (3) | (4) | (5) | (6) | (7) | (8) |