Schedule-7
(Relating to Sub-rule (1) of Rule 4)
Application for private license to operate kidney transplantation service

The Organ Transplantation Coordination Committee, Kathmandu.
Subject: Request for private license.
Whereas, I need the private license to operate the kidney
transplantation service;
Now, therefore, I have made this application, accompanied by the necessary fees, and setting out the following details, pursuant to Section 7 of the Act and Sub-rule (1) of Rule 4 of the Rules.
The certified copy of the following educational degree and certificate of experience obtained by me is attached herewith.

The above-mentioned contents and the description attached herewith
are true and correct, if proved false, I shall bear and pay according to law.
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Applicant doctor’s:
Name:
Signature:
Date:
Registration number and date of
Nepal Medical Council
registration number:
Address:
Format of certification of experience
(a) In the case of work in the central level hospital:
I hereby certify that Mr./Mrs./Miss……………………………, age of
………. years, a resident of………………, son/daughter/wife of
Mr……………….. has worked in the following post in this hospital for
the following period:-

Of the chief of hospital certifying that the above details are true and correct:
Name:
Signature:
Date:
Designation:
Name of Hospital:
Seal of Hospital:
Concerned doctor’s:
Signature:
Name:
(b) The committee shall make certification based on the documents
submitted by the concerned applicant in respect of experience of
works in a foreign hospital.