PARA MEDICAL BOARD

#5, New No.40/20A, Lakshmi Complex, First Floor, Opp Vani Vilas Hospital, Bengaluru-560002.

SUPPLEMENTARY EXAMINATION APRIL 2022 APPLICATION FORM

NAME AND ADDRESS OF THE YATHINDRA INSTITUTE OF PARA MEDICAL

INSTITUTION: SCIENCE, HASSAN

NAME OF THE COURSE: OPHTHALMIC TECHNIQUE

REGISTER NUMBER : 19CF0861

NAME OF THE CANDIDATE saniya

FATHER NAME Rahamath Ali

SUBJECTS APPLIED
SL NO. CLASS THEORY SUBJECT NAME Q P CODE ATTENDANCE CLASS PRACTICAL SUBJECT NAME ATTENDANCE

1 I Year Diploma PHYSICS 4101 86% II Year Diploma Practcal-I 87%

2 I Year Diploma CHEMISTRY 4103 86% II Year Diploma Practcal-II 87%

3 II Year Diploma Paper - I 5161 86%

4 II Year Diploma Paper - II 5163 88%

Fees need to Pay : Rs 1860 Du Number ............................ Applied Date : 14-03-2022

CERTIFICATE

I hereby certify that the Information furnished in the application is checked and found correct

Signature of the Candidate Signature of the Principal with

Institution Seal

FOR OFFICE USE ONLY

Application Verified By :
ELIGIBLE / NOT ELIGIBLE
Remarks :