APPLICATION FORM

Name of the Candidate :

Date of Birth : Gender : Male / Female, Urban/Rural

Father’s/Guardian’s Name :
Address :

Phone No : (1) (2)

Aadhar Card No :

Last College Name : __________________________________________________________

Medium of Instructions : _______________________

CET:2018 Hall Ticket No : ___________ Medical Rank ___________ Engg. Rank _____________

NEET Hall Ticket No : _______________________ Rank _______________________

Course : PCB ( )

Religion : Caste __________________ Category _______________

Facility : Day Scholar ( ) Day Scholar with Bus ( ) Day Scholar with Food( )
Semi Residential ( ) Residential ( ) A/c NRI ( )

Signature of Student Signature of Parent/Guardian

NOTE : Fee once paid will not be refunded
SSLC/PUC Original Marks Card is to be submitted at the time of admission and Documents will
be returned after the total fees clearance.
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FOR OFFICE USE ONLY

Admission No: Group: PCB

Total Prescribed Fee: ___________________

Receipt No with date: __________________________________________________
Remarks: ____________________________________________________________

Signature of Secretary Signature of Coordinator College Seal