582388-1940-Dentists-Regulations-1940 — Page 6

THE HONG KONG GOVERNMENT GAZETTE. JULY 5, 1940.

FORM NO. 5.

1,

of

Registration of Dentists Ordinance. 1946.

Application for Registration

under

Section 7 (a). (b) and (c).

hereby apply for registration as a dentist.

(a) I am registered under the Dentistry Ordinance. 1914,

or

*(b) I hold the qualifications set Out below entitling me to

registration under the Ordinance.

Declared at Hong Kong this

day of

1940.

Before me,

Justice of the Peace or Notary Public

Hồng Kong.

*Strike out inapplicable paragraph.

COUNCIL CHAMBER,

3rd July, 1910.

Photograph (passport size)

T. MEGARRY,

Clerk of Councils.

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