• 1st Choice of date :

  • 2nd Choice of date :

  • First Name :

  • Surname :

  • Date of Birth :

  • Address :

  • Designation :

  • Medical Council Registration Details :

  • Degree :

  • Telephone Number:

  • Email:

  • Year :

  • Institution :

  • University :

  • Name of The Institution :

  • Attach your Photo :

  • Residential Address :

  • Name of Institutions Designation:

  • Previous Endoscopy training if any :

  • Type of endoscopy procedures presently doing :

  • Mobile Number:

  • For Applicants within India

    (Please Attach a copy of the following)

  • PG Certificate:

  • Valid Medical Council Registration :

  • For Applicants Outside India

    (Please Attach a copy of the following)

  • Passport :

  • Visa :

  • Medical Registration details :

  • Report of good standing :

  • Kindly send the demand draft in favour of ‘Cochin gynecological endoscopic and infertility training centre’ payable at Ernakulam or Bank Transfer

    Bank Transfer details:

    Account Name : Cochin Gynecological Endoscopic and Infertility Training Centre
    Bank Name : State Bank of India
    Branch Name : Kathrikadavu
    Account No : 67258728596
    IFSC Code : SBIN0018060
    Nature of Account : Current Account
    SWIFT CODE : SBININBBT16

    Bank Address:

    SBI
    Grand Bay , OPP DD Trade Centre KattakaraJunction , Kaloor Kadavanthra Road Cochin -682017 Ernakulam

    Postal Address:

    Dr. Paul P.G,
    Paul’s Hospital, Kaloor, Cochin 682017, Kerala, India
    Email: drpaulpg@gmail.com
    Ph: 91-484-2344446, 2344447