currently working as, agrees for all the criteria set by the Society for the given course. Information provided by me is correct to the best of my knowledge. If the information provided by me is incorrect then I am liable for the prosecution by society as per their rules.

Date:- Place:

Note:-

1. Please attach self-attested photocopies of certificate/experience

• Degree & registration certificate
• Experience certificate
• If you are employed/ studying some other course, a letter of ‘no-objection’ from the employer/institution

2. Also send both hard copy as well as soft copy of the application & certificates to the ESOI office & Accreditation Coordinator.

For any correspondence contact –
Dr Pranay Oza – 9821214971

Office Address –
ECMO Society of India,
c/o Riddhi Vinayak Critical Care & Caardiac Centre, Riddhi Vinayak temple Lane, SV Road, Near N L High school, Malad (w), Mumbai 400064