1950_DENTISTS_REGULATIONS — Page 4

I,

of

Dentists Registration.

[CAP. 156

FORM 4.

Dentists Registration Ordinance.

(Chapter 156 of the Revised Edition).

Application for registration under

section 7 (a), (b), (c) and (e).

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

19

Before me,

}

Justice of the Peace or Notary Public

Hong Kong.

*Strike out inapplicable paragraph.

207

Photograph (passport size)