FORM-A
(See. Regulation 3)
FORM OF DECLARATION


1.Declaration

Persons applying for registration with State Medical Council or Board/Central Council of Indian Medicine shall forward alongwith his application form the following declaration duly signed by him, namely :-

(i) I solemnly pledge myself to consecrate my life to the service of humanity.
(ii) Even, under threat, I shall not use my knowledge contrary to the laws of humanity.
(iii) I shall maintain the utmost respect for human life from the time of conception.
(iv) I shall not permit consideration of religion, nationality, race, party politics or social standing to intervene between my duty and my patient.
(v) I shall practise my profession with consicience and dignity.
(vi) The health of my patient shall be my first consideration.
(vii) shall respect the secrets which are confined in me.
(viii) I shall give to my teachers the respect and gratitude which is their due.
(ix) I shall maintain by all means in my power, the honour and noble tradition of medical profession.
(x) I shall treat my colleagues as my brothers.
(xi) I shall maintain the standards of professional conduct and etiquette and observe the code of ethics, laid down in these regulations.
I make this declaration solemnly, freely and upon my honour and agree to abide by the same.

SIGNATURE OF APPLICANT

Name in full :
Date :
Address :