D D M M Y Y Y Y D D M M Y Y Y Y
2. Name (IN FULL) (as appearing in MBBS certificate)
3. Father’s/Husband’s Name
4. Mother’s Name
1 9
D D M M Y Y Y Y D D M M Y Y Y Y
7. STD Code Telephone No./Mobile No. 8. E-mail (Write in Bold & Clear manner)
2nd Choice
Examination Passed Subject Medical College University State Month & Year Result No. of
Attempts
(Pass / Fail)
M M Y Y Y Y
are correct.
Date: / / 2007
( In case, Candidate is not working, the above column may be attested by a Gazetted officer/Regd. Medical Practitioner )
NOTE: PHOTOCOPY OF THE FILLED UP APPLICATION FORM MUST BE RETAINED BY THE CANDIDATE FOR FUTURE USE.
NATIONAL BOARD OF EXAMINATIONS
NAMS BUILDING, ANSARI NAGAR, MAHATMA GANDHI MARG, NEW DELHI-110029
NON-SCANNABLE APPLICATION FOR CENTRALISED ENTRANCE TEST (CET-NBE) EXAM. 2007
INSTRUCTIONS :- Application Form No.
* INCOMPLETE APPLICATION FORMS WILL NOT BE CONSIDERED. E PE NE
* READ PROSPECTUS CAREFULLY BEFORE FILLING UP THE FORM.
* PLEASE SUBMIT THIS FORM IN ENVELOPE PROVIDED.
* ATTACH ALL ENCLOSURES WITH THIS APPLICATION FORM. Office Use Only
* USE BLUE/BLACK BALL PEN ONLY
Roll Number (to be assigned by NBE) DL
Control Number to be assigned by NBE
D D M M Y Y Y Y D D M M Y Y Y Y
2. Name (IN FULL) (as appearing in MBBS certificate)
3. Father’s/Husband’s Name
4. Mother’s Name
1 9
D D M M Y Y Y Y D D M M Y Y Y Y
7. STD Code Telephone No./Mobile No. 8. E-mail (Write in Bold & Clear manner)
2nd Choice
Examination Passed Subject Medical College University State Month & Year Result No. of
Attempts
(Pass / Fail)
M M Y Y Y Y
are correct.
Date: / / 2007
( In case, Candidate is not working, the above column may be attested by a Gazetted officer/Regd. Medical Practitioner )
NOTE: PHOTOCOPY OF THE FILLED UP APPLICATION FORM MUST BE RETAINED BY THE CANDIDATE FOR FUTURE USE.
NATIONAL BOARD OF EXAMINATIONS
NAMS BUILDING, ANSARI NAGAR, MAHATMA GANDHI MARG, NEW DELHI-110029
SPECIMEN APPLICATION FOR CENTRALISED ENTRANCE TEST (CET-NBE) EXAM. 2007
Application Form No.
INSTRUCTIONS :-
* THIS SPECIMEN APPLICATION FORM IS ONLY FOR PRACTICE. E PE NE
* READ PROSPECTUS CAREFULLY BEFORE FILLING UP THIS FORM.
* PLEASE DO NOT SUBMIT THIS SPECIMEN FORM.
* USE BLUE/BLACK BALL PEN ONLY Office Use Only
DL
N
Roll Number (to be assigned by NBE)
Control Number to be assigned by NBE
M
D D M M Y Y Y Y D D M M Y Y Y Y
2. Name (IN FULL) (as appearing in MBBS certificate)
3. Father’s/Husband’s Name
I
4. Mother’s Name
E C D M M Y Y Y Y
6. Date of Birth
D D M M
1
Y
9
Y Y Y
P
8. E-mail (Write in Bold & Clear manner)
S
1st Choice
2nd Choice
Examination Passed Subject Medical College University State Month & Year Result No. of
Attempts
Address: ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ City : ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○
State : ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○
(Pass / Fail)
M M Y Y Y Y
are correct.
Date: / / 2007
( In case, Candidate is not working, the above column may be attested by a Gazetted officer/Regd. Medical Practitioner )
NOTE: PHOTOCOPY OF THE FILLED UP APPLICATION FORM MUST BE RETAINED BY THE CANDIDATE FOR FUTURE USE.