APPLICATION NO.

Application Fee Rs. 500/-

Foundation of Ophthalmic & Optometry

Research Education Centre, India
(Regd. No. S/62385 of 2008)
(Regd. No. S/25854 of 1994)
Application Form for Admission to the Diploma in Ophthalmic Techniques
I Wish to be Admitted to DOT.
(Fill in block Latter)
1. Name of Applicant (Mr/Ms/Miss.

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2. Permanents Address.

:___________________________________________________________________________________________
:___________________________________________________________________________________________
:___________________________________________________________________________________________

3. Present Address.

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:___________________________________________________________________________________________
4. Contact No.

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5. Email Address.

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6. Date Of Birth.
7. Marital Status.

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8. Fathers/ Husbands Name.

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9. Referred By Name.

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10. Contact No.

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11. Local Guardians Name

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Relation with Student.

12. Last Exam Passed With Date

:___________________________________________________________________________________________
___________________________________________________________________________________________

Division and Name of Board

or University.

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13. Centres you wish to Join
:(I) ____________________________________________________________________________
Give Centres Code No. As given in instruction. :(II) ____________________________________________________________________________
To Candidates (enclosed on page i to vii).
:III) ____________________________________________________________________________
14. Details of the Examination passed High School onwards:
Examination
High School

Year

Division

Passed No.

Subjects

................................ ..................... ....................... ................................................................................................

Intermediate

................................ ...................... ........................ ...............................................................................................

B. Sc.

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15. Marks Obtained in the Intermediate (10+2) Examination:

1. English

................./100

2. Physics

................/100

4. Biology

................./100

5. Mathematics

................/100

3. Chemistry

................./100

16. Lists of Photocopy Certificated attached by the graduated officer should be attached kindly bring original certificates
at the time of interview.
A. Copy of High School Certificate and mark sheet.
B. Mark-sheet of Intermediate (10+2) passed
C. Mark. Sheet of B. Sc.
D. College Living Certificated
E. Any other. .....................................................................................................................................................................................
F. Character Certificate from the principal of the college last attended.
17. Bank Draft No. ........................... Payable at Delhi, Issuing Bank. ..........................................
( only Bank Draft are Acceptable)
Date: _____________________

Signature of Candidate

Instructions :
1. Residence in premises is compulsory if offered for all candidate.
2. Application must reach interviewing centre by the due date (2nd June every year with Bank Draft for Rs. 500/Rupees Five Hundred only) as application processing fee(Rs. 1000/-), in favour of the Foundation of Ophthalmic
& Optometry Research Education Centre - payable at Delhi.
3. All eligible candidates will receive a call letter, by post (under UPC) to appear for the interview.
4. Rs. 10000/- (Rupees ten thousand only) will be deposited by the candidate before the interview i.e. Rs. 4000/Rupees four thousand only) as security deposited fee to the respective institute and RS. 3000/- ( Rupees three
thousand only) for the Books (This will be product at the time of giving the admission letter).
5. Do not submit certificates in original . Only photostat copies be sent along with the application. Original
certificate must be produced at the time of interview.
6. Canvassing any form will disqualified the candidates
7. No correspondence will be entertained with the ineligible candidates of if application is sent at the time
Wrong Place.
8. The center does not bear any responsibility for postal delay/ loss in transit candidates are hence advice to send
And correspondence by Regd./Speed post / Counter.
9. Books once product will be taken back.

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FOR OFFICE USE ONLY

Interview No.

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Date of Calling of interview : ...........................................

Date of Receipt
Result

:.....................................
:......................................

Head office
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FOUNDATION OF OPHTHALMIC & OPTOMETRY RESEARCH EDUCATION CENTRE.

C-2/M-1, LAJPAT NAGAR-III, NEW DELHI-110024
TEL: 011-43444300(100 LINES) 011-41718116
MOB: 9810232030, 8595070014, 9650217309
E mail id. Pattnaik.nabin9@gmail.com/dplei.foorec@gmail.com
Www: drpattnaik.com