PPWS Application Form

Professional Protection & Welfare Scheme, IMA Telangana State. Restricted to members of IMA Telangana State.

Option 1

Manual submission

Print the form, fill it in block letters, enclose your certificates and Draft or Cheque, and send it to the Hony. Secretary, PP&W Scheme. The fee tables are in this PDF. Add 18% GST to the fee.

Download Blank Form

Option 2

Fill online

Fill the form below. Use Export PDF any time to download it filled in. Log in to save it, submit it and edit it later.

Fill Online

Applicant details

Full name (Dr.)

Name of the Hospital / Nursing Home

Date of birth

Name of Father / Husband

Address

Mobile You will need this to check your application status.

Qualification and registration

Qualification

University

Year of passing

Registration No

Registration year

Medical Council No

IMA membership

IMA Membership No

Local Branch of IMA

Scheme opted

Refer to the fee structure in the blank form PDF above, and add 18% GST to the fee.

Payment details

Demand Draft or Cheque in favour of "PP&W Scheme of IMA Telangana State", payable at Hyderabad.
Online: PNB A/C No 1969000100082217, IFSC PUNB0196900, Koti Branch, Hyderabad.

How will you pay?

Amount including 18% GST (Rs.)

Documents

JPG, PNG or PDF, up to 5 MB each.

IMA Life Membership Certificate

MBBS Degree Certificate

Speciality / Super Speciality Degree Certificate If you have one.

Telangana Medical Council Certificate

DMHO Registration Certificate If you have one.

Declaration I do hereby declare that the details furnished above are true and correct and I further agree to abide by all Rules & Byelaws of PP&W Scheme of IMA Telangana State and amendments to be made from time to time.

Your typed details are kept when you log in or create an account. Files need to be selected again.