Medicaps Application Form 2023-24

Application No: MU2308040

Personal and Parent Details

Personal Details
First Name ASHUTOSH Middle Name Last Name PATHAK
Email ASHUPATHAK3444@GMAIL.COM Mobile Number +91-6269831886 Blood Group
Nationality INDIAN Category GENERAL Religion HINDU
Aadhar Number 972807170325 Gender MALE Date of Birth 17/11/2003
Passport Details
Passport Number Country Place of Issue
Date of Issue Date of Expiry
Father Details
PLEASE ENTER PARENT'S FULL NAME AS MENTIONED IN THE 10TH MARKSHEET

Father Mobile
Father Name VIJAY PATHAK +91-9131590927
Number
Mother's Details
Mother's Mobile
Mother's Name DROPATI PATHAK
Number

Educational Qualifications
Course Details
Branch (Preference
Program B.SC. Branch (Preference) FORENSIC SCIENCE
2)
Branch (Preference 3)
10th Details
10th Academic Details

Year of Maximum Marks Obtained

Institute Name Board Marking Scheme
Passing Marks Obtained Percentage/CGPA
MADHYA PRADESH
GOVERNMENT HIGHER
10th BOARD OF SECONDARY 2021 PERCENTAGE 500 165 33.00
SECONDARY
EDUCATION

After 10th
12TH
Qualification
12th Details
12th Academic Details

Admit Card
Obtained
Institute Year of Result Marking Maximum Marks ID/
Board Stream Percentage/
Name Passing Status Scheme Marks Obtained Application
CGPA
No.
MADHYA
SARWASTI
PRADESH
SISHU MANDIR
12th BOARD OF SCIENCE 2023 DECLARED PERCENTAGE 500 342 68.40 22310378
SCHOOL
SECONDARY
AMANGANJ
EDUCATION

School Code 232012 Center Code 231020

Diploma Details
Diploma Academic Details

Institute Year of Result Marking Maximum Marks Obtained

Board/University Stream
Name Passing Status Scheme Marks Obtained Percentage/ CGPA
Diploma

Graduation Details
Graduation Details

Degree Stream Year of Passing Result Status Marking Scheme Maximum Marks Marks Obtained Obtained Percentage/ CGPA
UG
 Post Graduation Details

Degree Stream Year of Passing Result Status Marking Scheme Maximum Marks Marks Obtained Obtained Percentage/ CGPA
PG

Have you
Appeared in JEE
Mains?
JEE Mains Details

Exam Name Application No Year of Appearance Percentile CRL Rank

JEE Mains

Want to appear in the

Whether you want to
MU-SAT Examination for YES NO
avail hostel Facility
Scholarship?
Whether you want to
NO
avail bus Facility

Declaration
THE APPLICATION FEE IS NON-REFUNDABLE UNCONDITIONED TO YOUR ADMISSION. I AGREE TO THE TERMS OF PAYMENT OF APPLICATION FEE.

Applicant Name ASHUTOSH PATHAK Place PANNA Date 13/07/2023

Anti-Ragging Reference
Number

Upload Documents

upload your passport size

Aadhaar Card : YES 10th Marksheet : YES
photograph :

12th Marksheet : YES Diploma Marksheet : NO UG Marksheet : NO

PG Marksheet : NO Entrance Exam Marksheet : NO

Communication Details
Address for Correspondence
Country INDIA State MADHYA PRADESH District PANNA
City PANNA Address Line 1 PURANA BUS STAND Address Line 2 AMANGANJ
Is Permanent Address
Pincode 488441 Same As Address For NO
Communication?
Permanent Address
Country INDIA State MADHYA PRADESH District INDORE
City INDORE Address Line 1 INDORE Address Line 2 RAU
Pincode 453331