Licentiate of the Medical Council of Canada
Service Registration Form
PERSONAL DETAILS
Full Name
*
First Name
Middle Name
Last Name
E-mail
*
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Country
*
Phone Number
*
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Country Code
Phone Number
Emergency Contact Name
First Name
Last Name
Emergency Contact Number
Please enter a valid phone number.
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DOCUMENTS UPLOAD
Please upload all required documents Click here
Bio-Page of Passport
Upload Passport Bio Page
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SERVICE FEE PAYMENT OF $215
Once you click on SUBMIT, You will be redirected to the online payment page. In order for your application to be worked on please make the payment of USD$215. Please contact 02073216451 or 0503262050 for further enquiries, Thank You
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