APOLLO INSTITUTE OF HOSPITAL ADMINISTRATION

(Affiliated to Osmania University and approved by AICTE) (Sponsored by Apollo Hospitals Educational and Research Foundation)

Apollo Health City, Jubilee Hills, Hyderabad 500 096. Tel: 23543269, 23607777/5007, Fax: 040-23608050, E-mail: info@apolloiha.ac.in Website: www.apolloiha.ac.in

Affix your recent Photograph.

APPLICATION FOR M.H.M ENTRANCE TEST 2011

DD No___________ Date________ Bank____________________ Place_____________ Rs.___________

your name and fathers name as per your graduation certificate) 1. Name of the Candidate: (In Capital Letters) 2. Name of the Father: 3. Name of the Mother: D D M M Y Y Y Y

(Write

4. Date of Birth 5. Reservation category, if any (put a ST SC

BCA

mark) BCC BCD BCE GEN.

BCB

6. Residential Status (put a 7. Gender (put a mark)

mark)

Local

Non- Local

Other State

Male 8. Name of the qualifying examination passed: (for e.g. M.B.B.S., B.Sc., B.com.,B.D.S, B.P.T. etc) 9. Percentage of Marks secured in the qualifying examination 10. Address for Communication (In Block Letters)

Female

Pin Code Phone No With STD Code:_______________

District State Mobile No

: : :

_________________ _________________ _________________

E-Mail

_________________
P.T.O

10. Particulars of study of preceding seven (7) years starting from the qualifying examination. S. No Course/ Class Year of study Scholl/College/University Place, District and State

11. Occupation of Parent / Guardian 13. Permanent address

: :

12. Annual income of parent / Guardian:

Pin Code

Mobile No. Phone No.

Declaration: I hereby declare that the particulars furnished above are true and correct. Date: Place: Please Note: 1. Submit the application in to the Principal, AIHA. 2. Attach two 9x4 size self addressed Covers affixing Rs. 5/- postal stamp on each cover 3. Keep seeing the website www.apolloiha.ac.in for information 4. Please write your name, gender and sign the admit card (original and duplicate) before submitting application. 5. Incase you have not received admit card (Hall Ticket) for the Entrance Test, get a duplicate admit card one hour before the test at the examination centre by submitting a passport size photograph and proof of submitting the application with necessary fees. **************** Signature of the Candidate

APOLLO INSTITUTE OF HOSPITAL ADMINISTRATION

(Affiliated to Osmania University and approved by AICTE) Apollo Health City, Jubilee Hills, Hyderabad 500 096. Tel: 23543269, 23607777/5007, Fax: 040-23608050, E-mail: info@apolloiha.ac.in

Website: www.apolloiha.ac.in

M.H.M ENTRANCE TEST 2011. ORIGINAL ADMIT CARD

Admit Card Number

Date & time of Examination: Place of Examination: Name of the Candidate: Sex (put a mark) Male: Female:

Affix Recent Passport size Photograph here

Signature of candidate

Signature of convener

APOLLO INSTITUTE OF HOSPITAL ADMINISTRATION

(Affiliated to Osmania University and approved by AICTE) Apollo Health City, Jubilee Hills, Hyderabad 500 096. Tel: 23543269, 23607777/5007, Fax: 040-23608050, E-mail: info@apolloiha.ac.in

Website: www.apolloiha.ac.in

M.H.M ENTRANCE TEST 2011. DUPLICATE ADMIT CARD

Admit Card Number

Date & time of Examination: Place of Examination: Name of the Candidate: Sex (put a mark) Male: Female:

Affix Recent Passport size Photograph here

Signature of candidate

Signature of convener