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    PN Class I (Oct2018)

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    Denver Saldanha
    The Government of India's Director General of Civil Aviation (DGCA) is inviting applications for empanelment of Class I Medical Examiners. Doctors wishing to be empaneled must submit applications with required documents to the DGCA headquarters in New Delhi by October 30th, 2018. The application should be clearly marked and applications by email or fax will not be accepted. Doctors are advised to refer to the CAR on Medical Examiner Empanelment dated June 23rd, 2017 for more details on eligibility and empanelment process.

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    PN Class I (Oct2018)

    Uploaded by

    Denver Saldanha
    41 views3 pages
    The Government of India's Director General of Civil Aviation (DGCA) is inviting applications for empanelment of Class I Medical Examiners. Doctors wishing to be empaneled must submit applications with required documents to the DGCA headquarters in New Delhi by October 30th, 2018. The application should be clearly marked and applications by email or fax will not be accepted. Doctors are advised to refer to the CAR on Medical Examiner Empanelment dated June 23rd, 2017 for more details on eligibility and empanelment process.

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    PN Class I(Oct2018)

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    The Government of India's Director General of Civil Aviation (DGCA) is inviting applications for empanelment of Class I Medical Examiners. Doctors wishing to be empaneled must submit applications with required documents to the DGCA headquarters in New Delhi by October 30th, 2018. The application should be clearly marked and applications by email or fax will not be accepted. Doctors are advised to refer to the CAR on Medical Examiner Empanelment dated June 23rd, 2017 for more details on eligibility and empanelment process.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    41 views3 pages

    PN Class I (Oct2018)

    Uploaded by

    Denver Saldanha
    The Government of India's Director General of Civil Aviation (DGCA) is inviting applications for empanelment of Class I Medical Examiners. Doctors wishing to be empaneled must submit applications with required documents to the DGCA headquarters in New Delhi by October 30th, 2018. The application should be clearly marked and applications by email or fax will not be accepted. Doctors are advised to refer to the CAR on Medical Examiner Empanelment dated June 23rd, 2017 for more details on eligibility and empanelment process.

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    GOVERNMENT OF INDIA

    OFFICE OF THE DIRECTOR GENERAL OF CIVIL AVIATION


    OPP. SAFDARJUNG AIRPORT, NEW DELHI -110 003

    PUBLIC NOTICE
    Reference No: AV/22025/34/DMS/Med
    Dated : 4th October 2018

    Sub: EMPANELMENT OF CLASS I MEDICAL EXAMINER

    Applications are invited for DGCA Empanelment of Class I Medical


    Examiners. Doctors desirous of being empanelled as Class I Medical
    Examiners by DGCA may apply to Medical Cell, DGCA HQ, Aurobindo Marg,
    New Delhi – 110003 as per enclosed format.

    The envelope shall be superscribed ‘Application for Empanelment of


    Class I Medical Examiner’. Application by Email/Fax shall not be accepted.
    Kindly refer CAR on Empanelment of Medical Examiners for conduct of Class
    I Medical Examination dated 23 Jun 17 for further details.

    The last date of receipt of application form is 30 Oct 18.

    Director General of Civil Aviation


    APPLICATION FOR DGCA EMPANELMENT OF CLASS I MEDICAL EXAMINER

    1. Name of the Applicant : Passport Size


    2. Father’s Name : photograph to
    3. Date of Birth : be pasted
    4. Address :

    5. Address of Medical Facility :

    6. Whether Medical Facility is Owned or Rented:


    7. Email :
    8. Phone/Mobile No :
    9. Presently Employed with :
    10. Academic Qualification :
    S QUALIFICATION MEDICAL COLLEGE UNIVERSITY YEAR OF
    No PASSING
    1. MBBS
    2. MD
    (MEDICINE /
    AVIATION
    MEDICINE)

    11. Training in Aviation Medicine :


    (Not Mandatory if MD in AVIATION MEDICINE)

    12. Other Qualifications, if any :

    13. MCI/State Medical Council Registration No :

    14. Experience:
    S No Medical Centre/ PERIOD TOTAL PERIOD
    Institution/ Experience as FROM TO
    1. IAM/AFCME/MEC (E)

    Specify--------------------
    2. DGCA

    3. DGCA Approved Class I


    Medical Centre
    Specify--------------------
    4. Scheduled Airline

    Specify--------------------
    5. Class II Medical
    Examiner
    15. Co-opted Lab Details:
    S Lab Name Whether Email Address Contact
    NO NABL Number
    Accredited

    16. Co-opted Specialists/Consultant Details :


    S Name Specialization Qualification Address Contact
    No Number/Email

    Declaration:

    I, hereby declare and undertake that the information provided, statement made
    along with documents provided in this application are true and correct to the best of
    my knowledge and belief. I, further declare and undertake that no information/
    document relevant herein have been withheld or concealed. I understand that in case
    I have made any false or misleading statement or submitted any forged document
    while applying for the empanelment, the competent Authority may reject my
    application or withdraw my empanelment without prejudice to initiation of suitable
    actions as per the existing regulatory framework including institution of legal
    proceedings as applicable.

    Place:
    Date: Signature of the Medical Examiner

    List of documents to be enclosed:


    (a) Self attested Copy of MBBS Certificate
    (b) Self attested Copy of PG Certificate
    (c) Self attested Copy of Training in Aviation Medicine Certificate (If required)
    (d) Self attested Copy of MCI/State Medical Council Registration Certificate
    (e) Self attested Copy of Experience Certificate
    (g) Self attested Copy of NOC from Employer (if required)
    (h) Self attested Copy of NOC from Owner of the Medical Facility (if required)

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