AFFIDAVIT

I…………………………..………..S/D/W/O……………………………..……resident of…………………………………………..……..…..

………………………………………..having CNIC #….………………………………….Contact # ……………………………..…..

do hereby solemnly affirm and declare that I am registered with federal council (PMDC/PNC/NCH/NCT) as

…Doctor……………and my registration # is ……00000-P ……… that is valid up to……31-12-0000.………………….

I provide my services1. … …………………………………..…… 2.. …………Nil……..3…….…………Nil………………………….

At ……..(Name) ………………………………….. ……. Situated at (Address) ………..………………………………..………………

…………………………………..………Tehsil ……..………………………………….. ……………..District ……………….…………………

My timings at this HCE are from ……………. to ………………….…. On days from …………………. to …………..……..

I declare that I don’t provide my service in addition to this HCE/ I provide my services at following
other HCE;

1. HCE Name …………………………………..……… address … …………………………………..…………………………………

………………………..timings From …......... to …...........days from …………………… to ………………………..

The copies of my CNIC, degree / diploma and updated registration with federal council
(PMDC/PNC/NCH/NCT) submitted to the PHC along with this affidavit are true copies of my original
documents.
I declare that my name is not being used other than mentioned HCEs and I will inform PHC whenever I
withdraw my services from the said HCE(s). I also declare that I will follow the rules and regulations of
Punjab Healthcare Commission in true letter and spirit.

Deponent

The contents of the above mentioned affidavit are true and correct to the best of my knowledge and
nothing has been concealed therein.

Deponent