4/10/2014

ADMISSION FOR UG AWT 2013 (MBBS, BDS, BSC Nursing, BPT)

Application Form (* Print using A 4 size paper)

NAME Email Id Application No. DATE OF BIRTH FATHER'S NAME MOTHER'S NAME HOUSE NO. / STREET ADDRESS POST OFFICE / TALUK NAME CITY NAME STATE NAME PIN CODE PHONE NO. MOBILE NO. TOTAL ANNUAL INCOME OF PARENTS / GUARDIAN (IN RS.) GENDER RELIGION CASTE STATE OF DOMICILE COURSE & CATEGORY APPLIED FOR: M.B.B.S CENTRE FOR EXAMINATION MODE OF PAYMENT D.D NO. D.D DATE BANK NAME AMOUNT :: :: :: :: :: :: :: CAT-1 All India General Open CHANDIGARH DEMAND DRAFT 793656 09/04/2014 SBI BANK ROORKEE RS. 3900/:: :: :: :: :: :: :: :: :: :: :: :: :: :: :: :: :: :: ANI SHARMA dr.avisharma@live.com UG/2014/03872 1995-05-09 ANIL KUMAR SHARMA SADHNA SHARMA 1482 JADUGAR ROAD ABOVE VIJYA BANK CIVIL LINES ROORKEE UTTARAKHAND 247667 01332273633 09897043544 400000 MALE OTHERS OTHER\GENERAL UTTARAKHAND

I have read the Information Bulletin before filing this online application form. I hereby verify that all the above details entered by me in the application form are true to the best of my knowledge. I hereby certify that I have attached the following (Please tick the boxes only for the documents being submitted): For all candidates 1. Demand Draft 2. Two Passport Size Photos In addition, for candidates applying in either 'Christians with Service Agreement' category in MBBS or 'Christian Minority' category in BDS/BSc Nursing / BPT:

3. Domicile certificate (if applying in MBBS/BDS)

4. Affidavit of service (For MBBS Only) 6. Baptism Certificate 5. Letter of Service Commitment (MBBS only)

7. Church membership certificate

Signature of the candidate:-

http://cmcludhiana.in/ugawt/applications/print_form

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4/10/2014
Print Date:Date:Place:-

ADMISSION FOR UG AWT 2013 (MBBS, BDS, BSC Nursing, BPT)

Apr-10-2014

A PRINTED COPY OF THE COMPLETED FORM WITH ENCLOSURES AND DEMAND DRAFTS MUST REACH THE OFFICE OF THE REGISTRAR, C.M.C. LUDHIANA, PUNJAB-141008 BY THE LAST DATE

http://cmcludhiana.in/ugawt/applications/print_form

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