ONLINE APPLICATION FORM 2017


COURSE
B.D.S. M.D.S.

      Orthodontics & Dentofacial Orthopaedics
      Conservative Dentistry & Endodontics
      Prosthodontics and Crown & Bridge
      Periodontology
      Paediatric & Preventive Dentistry
      Oral Pathology & Microbiology and Forensic Odontology
APPLICANT DETAILS
Name :   
 
Age :   
 
Date of birth :   
 
Gender :    Male Female
 
Nationality :   
 
Religion :   
 
Caste :   
 
Blood group :   
PARENT / GUARDIAN DETAILS
Father's name :      Father's occupation :   
 
Mother's name :      Mother's occupation :   
 
Permanent address :   
 
Pincode :   
 
Phone Number :   
 
Mailing address :   
 
Email address :   
 
Name of local guardian (If applicable) :   
 
Address :   
 
Pincode :   
 
Phone Number :   
 
EDUCATIONAL DETAILS
Basic qualification obtained :   
 
Name of previous institution :   
 
Name of University / Board :   
 
Total marks :   
 
Total percentage :   
 
 
 
Percentage of marks in Science (PCB) :       English:   
 
Name of qualifying examination :   
 
 
 
NEET Roll No :       NEET:    Qualified Not Qualified
 
Percentile Score :       Total Marks Obtained:   
 
 
Extra curricular activities :   
 
DECLARATION
I hereby state that the above particulars are true to the best of our knowledge and we promise to abide by the rules and regulations of the institution maintaining descipline and decorum at all times.
 

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