GOVERNMENT OF MAHARASHTRA

COMMISSIONERATE, COMMON ENTRANCE TEST CELL, MUMBAI

NEET UG 2021 – Preference Form System
SCRUTINY FORM PROVISIONAL
STATE MERIT NO.:__________
Scrutiny Center : ______________________

Candidate Name : ________________________________________ Neet Roll No.:_________________

Neet Merit No. : ______________ Neet Marks Persontile : ______________ Category : _____________

Region : ROM / VIDARBHA / MARATHWADA ___________HSC PCB : _____/_____ HSC E :_____/100

Mobile No.: _____________ Ear – Marking Only of Reserved Candidates

Open Reserved

Signature of Candidate
(Arrange a set of original certificates and one set of attested photocopies separately in the order given below for verification)

(For Office Use Only)

Admit Card of NEET UG 2021-22 Remarks :

Copy of NEET-CET Online Application Form
(Latest)
NEET-UG-2021 Mark Sheet
Nationality Certificate/Valid Indian Passport Eligible : Yes / No
Domicile Certificate
H.S.C. (or equivalent) examination marksheet
If not eligible, reason/s________________________
S.S.C.(or equivalent) passing certificate (for
Date of Birth)
Adhar Card ___________________________________________
Medical fitness certificate (Annexure-1)
Person with disability Certificate (PWD)
If applicable

Caste Certificate Any other remarks :___________________________

Caste Validity Certificate
Non Creamy layer Certificate Valid upto ___________________________________________
31/03/2022 (VJ,NT-1,NT-2, NT-3. OBC
Including SBC) ___________________________________________
Specified Reservation
D1/D2/D3 : Ex-servicemen Certificate, Actual
service certificate
D3 : Transfer Certificate
MKB : Dispute area cert. Mother tongue cert. Sign of Scrutiny Officer
EWS Eligibility Certificate
Orphan Certificate

Dean
Government Ayurved College,
Jalgaon
Sign of Clerk
 GOVT. AYURVED COLLEGE,JALGAON
APPLICATION FOR ADMISSION
TO B.A.M.S 1 ST YEAR 2021-2022 Photo
(Application regarding the applicant) (iq.kZ ekfgrh Hkj.ks vko';d vkgs)

Name Middle Name Last Name

Student full Name (English) :- -----------------------------------------------------------------------------------------------

nsoukxjh fyih (ejkBhr ukao) :- ------------------------------------------------------------------------------------------------

Father full Name :- ------------------------------------------------------------------------------------------------

Mother full Name :- -------------------------------------------------------------------------------------------------

S.S.C School Name & Board Name :- -------------------------------------------------------------------------------------------

H.S.C College Name & Board Name :- ------------------------------------------------------------------------------------------

Address for Correspondence :- -----------------------------------------------------------------------------------------------

-------------------------------------------Mobile No :- ---------------------------------------

Permanent Address :- ------------------------------------------------------------------------------------------------

----------------------------------------------------------------Rural/Urban

Date of Birth :- DMY :- -----------------------In Words: ---------------------------------------------------

Place of Birth :- -------------------TQ:---------------Dist:-----------------------State: ----------------------

Nationality :- ---------------------------------------------------------------------------------------------------

Married/Unmarried :- ---------------------------------------------------------------------------------------------------

Category :- ------------------------------------Cast:- --------------------------------------------------------

Father/Guardians Occupation :- --------------------------------------------------------------------------------------------------

Guardians Yearly Income 31.03.22 :- --------------------------------------------------------------------------------------------

Student Blood Group :- --------.Voter ID no :- ----------------------.Aadhar No :-----------------------------------

Particulars Regarding College Education –

Exam Board & Year of Class No. of Total Obtained % of Obtained

Name University passing Attempt marks Marks Marks Marks for
Name PCB
10TH NA
12TH
NEET 21
Instruction to the Applicant
1-All the details in the application form should be properly filled
2-Incomplete application will not be considered.
3-Certified true copies which is required. Should be attached.

Student sign Dean

Government Ayurved College,
Jalgaon
Admission UG (Ayurved)
 GOVT. AYURVED COLLEGE, JALGAON
NEET – 2021-22, B.A.M.S.-1ST YEAR FOR 2021-22
Application Form
Name of Student: - _____________________________________________. Caste _______________

Category :- ________ Air No. _________Quota___________ NEET Mark ______Percentage_________

Marks – Physics ________ Chemistry_________ Biology ______ English (Total PCB ___________)

E-Mail Id_____________________________Mo.No…______________.Mo.No Parent __________

Sr.No List of Photocopies of relevant Documents to be attached with Application Form YES/NO
1 Selection Letter of Competent Authority (NEET COPY) (FOR AIQ)
2 NEET -2021-22 Admit Card
3 Marksheet of NEET UG – 2021-22 Examination
4 (NEET-CET) Online Downloaded application Form
5 Nationality & Domicile Certificate
6 H.S.C. (12th) Passing Certificate
7 H.S.C. (12th) Statements of Marks
8 S.S.C. Passing Certificate
9 Medical fitness Certificate
10 T.C./Leaving Certificate
11 Gap Certificate (If Applicable)
12 Caste Certificate (If Applicable)
13 Caste Validity Certificate (CVC) (If Applicable)
14 Non-Creamy Layer Certificate (for VJ, NT-1, NT-2,NT-3, & OBC/SBC) Obtained /
Valid up to 31.03.2022
15 EWS Certificate
16 Other Necessary Certificate (For Defense/PH/Hilly area/MKB, Other)
17 Migration Certificate for CBSE & Other University Admission
18 Physically handicapped certificate
19 Colour Aadhar Card Necessary
20 Voter Id Card Xerox Copy and Recent Passport size colour photographs 8 (Eight)
copies (Write name,NEET rank & Mobile number on backside of each photograph
21 Gazette notification (In case of change of name)
22 Demand Draft –in favour of “ Dean, Government Ayurved College,Jalgaon &
National Insurance Company Ltd, Kolhapur
He/She has not submitted necessary Certificate i.e.
1) 2) 3)
Sign Of Documents Scrutiny Committee Admission UG (Ayurved)

Member-1 Member-2 Member-3

Remark

Dean,
Govt. Ayurved College, Jalgaon