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Application Form

For Admission to International MBBS Program – Batch 2019 – 20

Personal Details:

Full Name:

Father/Guardian's Name:

Father/Guardian Occupation:

Father/Guardian's Annual Income: Rs. / Year

Sex: MaleFemale

Date of Birth:

Marital Status:

Nationality:

Passport Status: If Ready, PP No.

If not, Application No:

Present Address:

Pin Code:

Mobile:

Email:

Education Qualification:

Total Marks in 10+2:

% Marks in 10+2:

% Mrks in PCB:

% Marks in English:

Applied for NEET 2019?:

Yes/No Qualified in NEET 2019?:

NEET Percentile Score:

Country / College / University Preference:

How did you know about us:

News PaperInternetTV AdvertisementSeminarLeaflet/PamphletFrom a friend

If Other:

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