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STATE COUNCIL OF DIPLOMA IN MLT & MRT, ODISHA
APPLICATION FOR REGISTRATION UNDER DMLT/DMRT COUNCIL,ODISHA
First keep ready the Scan copy of Documents mentioned against (a) (b) (c) or (d) in .jpg / .jpeg Formats and then fill up the details information as mentioned below
*
Minimum Requirements
(a) Require amount of Challan paid through SBI e-Pay / SBI Collect through Online Mode Only (No Bank Draft will be accepted)
*
(b)
Scan copy of passport size colour photograph (4.5cm x 5 cm pixel 150 less than 50 KB) and Scan copy of Signature (6 x 1.5 cm 250 pixel 20KB)
*
(c) Scan copy of Pass out certificate of DMLT/DMRT and CLC / TSLC and Conduct last attended (
For New/Fresh Registration
)
*
(d)
Scan Copy Existing Registration Certificate and Pass out certificate of DMLT/DMRT (
For Renewal Registration/Duplicate Registrationss
)
*
Please Fill up the Following Information to apply for Fresh Registration / Renewal of Registration/ Duplicate Registration under DMLT/DMRTCouncil, Odisha
Please select the type of Registration
*
(Fresh/Renewal/Duplicate etc)
Select Registartion Type
New or Fresh Registration
Renewal Registration
Duplicate Registration
Please select the Course you have passed out
*
Select
Diploma in Medical Laboratory Technology
Diploma in Medical Radiation Technology
Please enter Aadhar Number
Please select the Year of passing of the Course
*
Select
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
Please select the Name of the Institution from which you have passed out
*
If select others ,please enter the Institute Name
Enter SBI e-Pay / SBI Collect Reference No (DUXX)
*
Enter SBI Bank Reference No (IGXXX)
*
(If there is no such refernce number, write same DUB number here)
Please enter the Amount Paid (INR)
*
Please enter the Date of Payment
*
(DD/MM/YYYY)
Enter your Full Name (As per 10th certificate)
*
Enter your Father Name (As per 10th certificate)
*
Enter your Mother's Name
Date of Birth (As per 10th certificate)
*
(Select from the Calender)
Gender / Sex
*
Select
Male
Female
LGBT
Please enter your Address Details
*
(At-Po-PS-Via-Dt-Pin)
Please enter your Contact Valid Mobile No
*
Please enter your valid e-mail ID
*
Examination held in the Month, Year
*
(like June 2018)
(
As mentioned in Pass Certificate or Regd. Cert
)
Duration of the Course (From)/ Date of admision / Joining in the Training
*
(DD/MM/YYYY)
Duration of the Course (To)/ Date of Completion / Relieving from the Training
*
(DD/MM/YYYY)
Roll no issued by DMLT/DMRT Board
(
For New / Fresh Registration
)
Existing Registration Number given by Board
(
For Renewal / Duplicate Regd. only
)
Existing Registration Date
(
For Renewal / Duplicate Regd. only
)
(DD/MM/YYYY)
Existing Registration Validity Till
(
For Renewal / Duplicate Regd. only
)
(DD/MM/YYYY)
Name of the Examining Body / Board / University
*
Date of declaration of the Result (As per certificate)
(DD/MM/YYYY)
Upload your Signature
*
(Scan Copy of Full SIgnature
size 6 cm x 1.5 cm
)
Upload your photo
*
(
Scan Passport colour photo
size 4.5 cm x 5 cm
)
Upload Scan Copy of Passout Certificate
*
(
For New / Renewal / Duplicate Registration only
)
Upload Scan copy of CLC/TSLC & Conduct
*
(
For New Registrations
) or Existing Registratioon Certificate (
For Renewal / Duplicate Registrations
)