1977 Ed.]
Dentists (Registration and Disciplinary Procedure) Regulations
[CAP. 156
A 17
[Subsidiary]
4. I hold the following qualifications--
Declared at
this
day of..
19.........
Before me,
Commissioner for Oaths
or
Notary Public
at
Photograph
FORM 3
DENTISTS REGISTRATION ORDINANCE
(Chapter 156)
CERTIFICATE OF REGISTRATION
No.
(s. 10 & reg. 7.) L.N.177/77.
I hereby certify that the following is a true copy of particulars extracted from the entry in the Register-
Name
Address
Date of Registration
Fee paid: $450, or exempt under section 30 for the reason
stated below
FORM 4
[Deleted, L.N.177/77]
Qualifications
Photograph
Registrar.
19......