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+91 91777 34565 / 091770 91999

Application Form

For Admission to International MBBS Program – Batch 2021 – 22

    Personal Details:

    Full Name:

    Father/Guardian's Name:

    Father/Guardian's Occupation:

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

    Sex: MaleFemale

    Date of Birth:

    Marital Status:


    Passport Status: If Ready, PP No.

    If not, Application No:

    Present Address:

    Pin Code:



    Education Qualification:

    Total Marks in 10+2:

    % Marks in 10+2:

    % Marks in PCB:

    % Marks in English:

    Applied for NEET 2020?:

    Yes/No Qualified in NEET 2020?:

    NEET Percentile Score:

    Country / College / University Preference:

    How did you know about us:

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    If Other:

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