Diploma in Panchabhautik Chikitsa DPCH Online Form

First Name*

Middle Name

Sur Name*

*Name as it should appear on the certificate

Gender

MaleFemale

Date of Birth*

Address 1*

Address 2*

City*

State*

Pincode*

Phone number

Mobile number*

Alternate mobile number(relative or friend)

Email id*

Alternate Email id

Qualification*

Name of the institute*

University*

Year of passing*

*Upload document in given format only - jpg, jpeg, png, bmp, pdf. Upload image/file size upto 2MB per file.

• PAN Card* (Required)

• Degree certificate / Pass certificate*

• Proof ID* (Aadhar Card / Voting Card / School Bonafide)

• Proof of address* (Aadhar Card / Voting Card / Light Bill / Phone Bill / Driving License)

• CCIM / State council / Provisional registration*

• Photo*

Cash deposit in Sangli OfficeChequeBank transferDemand Draft

I hereby confirm that the information I have provided on this application form is (to the best of my knowledge) true, accurate, current and complete; and I agree to notify VDPCK promptly if any information contained on this application form should change, in order to keep it true, current and complete.

I hereby declare that I shall be disciplined and shall adhere to all the rules and regulations of VDPCK. I have read and fully understood the terms and conditions” given overleaf before filling in the
application form and unconditionally accept them all binding on me.

I hereby undertake to pay all charges raised on account of services availed.

agree to all terms and conditions

• Please fill the form completely and furnish all details required there in.

• Please upload all the relevant documents and photo in jpg format.

• All disputes with regard to this course are subject to the jurisdiction of sangli.

• Online payment should be done using "payment" button.

• Cash payments are not accepted and VDPCK is not responsible for any cash payments made.

• Certification of course completion would be awarded only after payment of full fee and successfully passing the final examination.

• VDPCK reserves the right to disqualify a candidate for providing false information, submitting improper documents or for misconduct in a particular course.

• VDPCK reserves the right to revise/change the curriculum, the course structure or course delivery methodology without prior notice.

• Fees once paid will not be refunded. Fee transfer to other person is not entertained in any circumstances.

• The payment will be refunded completely if the applicant is not selected for the program.

• The application form will be processed only after payment is realized / received by VDPCK.

• Candidates shall be eligible to attend contact program only after full payment of fee and completion of lecture and live sessions schedule.

• Contact programs shall be conducted in batches and therefore may not start immediately after completion of study modules. This may result in extended duration of the entire course.

• Candidates shall be informed about the dates of contact program in advance. Once intimated, it is necessary for the candidate to attend the contact program.

I have read, understood, agree and abide by the terms and conditions lay down by VDPCK