1982 Ed.]
Medical Practitioners ( Registration and [CAP. 161
Disciplinary Procedure) Regulations
A 21
[Subsidiary]
3. I hold the following qualifications--
and have had the experience described in the Medical Registration Ordinance.
Declared at *
this.......... day of
19..........
Before me,
Commissioner for Oaths
or
Notary Public.
*Insert place of residence of applicant.
Photograph
FORM 4
THE MEDICAL COUNCIL OF HONG KONG
MEDICAL REGISTRATION ORDINANCE (Chapter 161)
MEDICAL PRACTITIONERS (REGISTRATION AND DISCIPLINARY PROCEDURE) REGULATIONS
CERTIFICATE OF REGISTRATION
[reg. 7.]
I hereby certify that the following is a true copy of particulars extracted from the entry in the Register---
Name
Address
Date of registration
Qualifications
Fee paid: $450.
or free for the reason stated below-
Registrar.
19........
G.N.A. 20-62. L.N. 3/76.