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JIPMER MBBS Form 2017 PDF
JIPMER MBBS Form 2017 PDF
ThanksforsubmittingyourApplicationForm311624whichcanbeusedforallfuture
correspondence
TransactionNo: IGABGBNWK5
Amount: 1200.00
Personal Details
ApplicationNumber: 311624
NameofTheCandidate: BADIREDDYSIVAKUMAR
Father'sName: BADIREDDYVENKATAGOPALAKRISHNA
Mother'sName: BADIREDDYTULASILAKSHMI
DateofBirth: 05/07/1999
WhetherOPH: No
Sex: Male
Nationality: Indian(ResidentIndianNational)
Puducherryresident: No
CasteState: AndhraPradesh
EntryNo: 011700991227
EmailID: gopalkrishna.bv@gmail.com
Category: OBCNonCreamyLayer
MobileNo: 9394094006
Qualication Details
Status: Completed
Subject: Physics,Chemistry,Botany,Zoology
NameofSchool/College: SRICHAITANYASAIBHARATIJUNIORCOLLEGE
School/CollegeCity: VIJAYAWADA
NameoftheBoard/University: AndhraPradeshBoardofSecondaryEducation
MonthofPassing: July
YearofPassing: 2017
Percentage: 95.8
Other Details
Parent'sEducationalBackground: FatherGraduate
Parent's/Gaurdian'sOccupation: GovernmentService
Parent's/Gaurdian'sSpecificOccupatio: TEACHER
Parent'sAnnualIncome: 6Landabove
Present Address
https://cdn.digialm.com/EForms/SBIAfterPaymentAction.do?51983ZZ827ZZonline 1/2
5/3/2017 JIPMERMBBSForm2017
AddressLine1: 42/6/15,KOTHAPETA,RAJAHMUNDRY
State: AndhraPradesh
City: EastGodavari
Pincode: 533101
AddressLine1: 42/6/15,KOTHAPETA,RAJAHMUNDRY
State: AndhraPradesh
City: EastGodavari
Pincode: 533101
ID Proof Details
IDProof: AadhaarCardwithPhotograph
IDProofNo: 643996150817
PreferredExamCityOption1: Rajahmundry
PreferredExamCityOption2: Visakhapatnam
PreferredExamCityOption3: Vizianagaram
Declaration
IherebydeclarethatIhavecarefullyreadtheinstructionsandalltheparticularsstatedinthisapplicationformaretrueandcorrecttothebestofmy
knowledgeandbelief.Ifanyoftheseinformationprovidedisfoundfalse/incorrect,IshallabidebytheactionsanddecisionstakenbytheJawaharlal
InstituteofPostgraduateMedicalEducation&Research.
IherebydeclarethatIhavereadtheNonDisclosureagreementinPageNo.18oftheprospectus.
Version 12.03.00
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