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APPLICATION FORM

For Admission to International MBBS Program – Batch 2018 – 19

Personal Details :

Guardian Occupation :

Parent's Annual Income: Rs. / Year

Sex : MaleFemale

Date of Birth : Year Month Day

Marital Status :

Nationality :

Passport Status : If Ready, PP No.

If not, Application No :

Present Address : :

Pin Code :

Mobile : E-mail :

Education Qualification :

Total Marks in 10+2 :

% MArks in 10+2 :

% Mrks in PCB :

% Marks in English :

Applied for NEET 2018?:

Yes No Qualified in NEET 2018?:

Yes No NEET Percentile Score :

Country/ College/ University Preference :


How do you know about us :

News PaperInternetTV AdvertisementSeminarLeaftlet/PumpletFrom a friend

If Other :

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