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Registration Form

Registration Slip : Medical Stream

Roll No: Candidate Name: Father Name : Remark : 1212031 GEETHU BABU BABU T I All India Rank : Mother Name : Date of Birth : 2898 LOVELY BABU 27-02-1986

QUALIFIED FOR ON-LINE CHOICE FILLING PROCESS-ELIGIBLE FOR UR SEATS

Email Id: Phone No.: Mobile No.: Registration Date: Address: Pincode:

babu_csl@yahoo.co.in 0484-2786365 9995107103 2-5-2012 Time: 10:53:09

Gender: Physical Handicapped: Category:

FEMALE NO UR

THURUTHIYIL HOUSE, TEMPLE ROAD THIRUVANKULAM, ERNAKULAM,KERALA 682305

Note: Candidate registered successfully, Login Credentials are required to be kept confidential. All care must be taken to protect the Credentials.
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