Registration No.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA
APPLICATION FORM FOR ADMISSIONS TO M.D/M.S (UNANI) COURSES (2007-08) NATIONAL INSTITUTE OF UNANI MEDICINE, BANGALORE
Please fill in all the entries in CAPITAL LETTERS with BALL PEN only.
1. Preference(s) of Subject for Admission is compulsory (Write subject codes in the boxes in order of preference)
Subject Code Options in order of Preference Subject Code

Subject Moalejat Ilmul Advia Tahaffuzi wa Samaji Tib Ilmul Qabalat wa Amraze Niswan

For Office Use Date of Receiving of Application Fee paid (Rs.) Signature of Receiving Clerk

01 02 03 04

I II III IV

2. Personal Details Name (Use CAPITAL LETTERS only. Leave a blank box between First, Middle & Last Names)

Date of Birth
DAY MONTH YEAR

Age in years Gender
As on 31-08-07 1.Male 2. Female

Category Mother’s Name
1.General, 2.In-Service, 3.SC, 4.ST, 5.GOI Nominee

Nationality

Father’s Name (Use CAPITAL LETTERS only. Leave a blank box between First, Middle & Last Names)

3. Details of Qualifying Examination Examination
I

Name of College & Place

Board/ University

Year of Passing

%

Aggregate %

Date of Completion of Internship

BUMS Annual / Professional

II III IV V

4. Details of Fee

Draft No.

Date

Amount (Rs.)
DECLARATION BY THE APPLICANT

Name of Bank

I..............………………………………….……..........S/o or D/o...……………………………………................declare that all the statements given in this application form are true to the best of my knowledge. I understand that if any of the statements are found wrong, my admission will stand cancelled. If admitted, I will abide by the rules & regulations in force in NIUM and as amended from time to time and pay the prescribed fees.
5.Photograph 6.Present Address for Correspondence 7.Permanent Address

Affix latest passport size photograph duly attested DO NOT STAPLE

PIN Phone No. with STD Code: Mobile No. E-mail: Date: Place:

PIN Signature of the Candidate

Registration No.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA HALL TICKET
ENTRANCE TEST FOR ADMISSIONS TO M.D/M.S (UNANI) COURSES (2007-08)

Office Copy
Date of Entrance Test: 22/09/2007 Time: 10.00 am Venue of the Test: National Institute of Unani Medicine, Kottigepalya, Magadi Main Road, Bangalore-560091

Categories: Tick (√) General In-service SC ST GOI Nominee (Deficient States) Affix latest passport size photograph duly attested DO NOT STAPLE

Mr/Ms.……………………………….……………………………………………..………….. Son/Daughter of Mr……………………………………………………………….……………

S. No.

Subject Moalejat Ilmul Advia Tahaffuzi wa Samaji Tib Ilmul Qabalat wa Amraze Niswan

Options in order of Preference

01 02 03 04

Signature of the Candidate

Signature of Chief Superintendent Entrance Test

Registration No.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA HALL TICKET
ENTRANCE TEST FOR ADMISSIONS TO M.D/M.S (UNANI) COURSES (2007-8)

Student Copy
Date of Entrance Test: 22/09/2007 Time: 10.00 am Venue of the Test: National Institute of Unani Medicine, Kottigepalya, Magadi Main Road, Bangalore-560091

Categories: Tick (√) General: In-service SC ST GOI Nominee (Deficient States) Affix latest passport size photograph duly attested DO NOT STAPLE

Mr/Ms.……………………………….……………………………………………..………….. Son/Daughter of Mr……………………………………………………………….……………

S. No.

Subject Moalejat Ilmul Advia Tahaffuzi wa Samaji Tib Ilmul Qabalat wa Amraze Niswan

Options in order of Preference

01 02 03 04

Signature of the Candidate

Signature of Chief Superintendent Entrance Test

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