Application No : 8

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APPLICATION FOR ADMISSION TO BDS COURSE FOR THE ACADEMIC YEAR 2017-18 UNDER MANAGEMENT QUOTA

Registration No.(Office Use Only) :   

1. Name (in Block Letters) :                

a. Name of Father /Guardian :           

2. Address for Communication :          

                                    E-mail:         

3. Phone No.with STD Code : Res.      Mob:


4. Gender : Male Female Trans Gender Male Female Others

5. Date of Birth :       Age as on 31.12.2017

6. Religion & Caste :

7. Community to which the : SC ST MBC BC OTHERS

application belongs             


8. Candidate belongs to Telugu Speaking : Yes No

9. Details of SSLC/Matriculation Examination:

Examination Passed Registration No Month & Year of Passing Marks Secured Maximum Marks Name of the School and Place

10. Details of Qualifying Examination passed:

Exam Passed Reg. No/Roll No Month & Year of Passing Marks Secured Maximum Marks Result Name of the School and Place Name of the Board

11. Marks in Qualifying Examination (HSC/Intermediate)

Subject Month & Year of Passing Max. Marks Min. Marks % of Marks
English
Physics
Chemistry
Botany
Zoology
Biology

12. Details of NEET Examination passed:

a) Registration No :                     

b) NEET – 2017 Mark Secured :    

c) Percentile :                              

Amount:

Bank:

D.D.No:

Date:

d) Rank – State/All India :           

13. Detail of Demand Draft towards Fee of Rs. 250/- Paid: 

JOINT UNDERTAKING BY THE APPLICANT AND THE PARENT / GUARDIAN

I, .,son/daughter of hereby solemnly declare that the information furnished and the statements given and the enclosures are true, correct, complete and no relevant fact is suppressed. I,further declare that if any information found to be false at a later date on verification, I will be liable to forfeit seat and / or removal from the rolls of the institution at whatever stage of study may be besides making liable for criminal prosecution. I shall abide by the rules and regulations of the admission and the college to which get admitted to.

Station:

Date :

Signature of the Applicant

Signature of Parent / Guardian

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