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Comedk

This document contains an application form for COMEDK UGET-2013, which is an entrance exam for admissions to MBBS/BDS/BE programs in Karnataka universities. The summary provides instructions for applicants on filling out the application form correctly, attaching required documents like a demand draft, photo, signature, and certificates. It outlines the application process and states that the completed form must be sent to COMEDK's office in Bangalore by April 15th.

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Movva Praneeth Chowdary
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184 views2 pages

Comedk

This document contains an application form for COMEDK UGET-2013, which is an entrance exam for admissions to MBBS/BDS/BE programs in Karnataka universities. The summary provides instructions for applicants on filling out the application form correctly, attaching required documents like a demand draft, photo, signature, and certificates. It outlines the application process and states that the completed form must be sent to COMEDK's office in Bangalore by April 15th.

Uploaded by

Movva Praneeth Chowdary
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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4/3/13

Print Application

For those intending to apply to member institutions seeking admissions


to 1st Year MBBS/BDS/BE for the year 2013-2014

APPLICATION FORM FOR COMEDK UGET-2013

_____________________________________________________________________________________________

Application Number: Applicant Name: Course Applying for: Date of Birth: Test Location Choice: Gender: Nationality: Belongs to: By Birth / Domicile: Category: Parent's Annual Income: Address:

162299
MOVVA PRAHAS CHOWDARY MBBS/BDS 14/12/1995 BANGALORE MALE INDIAN NON-KARNATAKA GM 300000.00 49-54-5/1/1 BALAJI HILLS , SEETHAMADHARA VISAKHAPATNAM VISAKHAPATNAM ANDHRA PRADESH 530013 08912564873 [email protected] M M G PRASAD DD Amount: Rs.1200/Mobile No.: 9030990069

Please affix your recent passport size colour photograph here (inside the box)

City: State: Pincode: Phone No.: Email ID: Parent's/Guardian's Name: Payment Details:

DD No.: 742958 DD Date 02/04/2013 Drawee Bank: STATE BANK OF INDIA Name of Institution Last Studied: NARAYANA JR COLLEGE Place of Institution Last Studied: VISAKHAPATNAM

Year of Passing: 2013 10th Std Registration Number: 4198246 Declaration: I hereby declare that the particulars given in this form are true to the best of my knowledge & belief.

Date:

Place:

https://www.comedk.org/main/UGET/UG_PrintApplication.aspx

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4/3/13

Print Application

Note: The Following enclosures to be attached along with the application form in the below mentioned order: 1. Demand Draft has to be drawn from the nationalized bank in favour of "COMEDK" (check for the correct spelling) , payable at Bangalore (DD must be payable at Bangalore only). Rs.1200/- (One Thousand Two Hundred Only) for 3 subjects (PCB or PCM) i.e. MBBS/BDS or B.E and Rs.1500/- (One Thousand Five Hundred Only) for 4 subjects (PCMB) i.e. MBBS/BDS and B.E.. Application number, applicants name & contact number to be written at the back of the Demand Draft. Check for the bankers signature on the Demand Draft. 2. Printed Online Application Form The completed application form must have Candidates photo should be pasted (within the box provided) Candidates signature (within the box provided) Left forefinger impression of the candidate (within the space provided) Candidates parent/guardians signature (within the box provided) 3. Printed Online Date of Birth Certificate / Identity Proof (COMEDK copy). Date of Birth Certificate / Identity Proof; is an auto generated document which is generated along with the application form. It is printed as Date of Birth Certificate / Identity proof (COMEDK Copy). This document needs to be duly signed by the candidate. The completed Date of Birth Certificate / Identity Proof must have Candidates photo should be pasted (within the box provided) Candidates signature (within the box provided) 4. Photocopy of 10th Standard Marks Card or School Leaving Certificate indicating the candidate's Date of Birth. Candidates belonging to SC, ST and OBC of Karnataka would be considered, provided they furnish the Photocopy of the following Certificates: a. SC / ST: Caste Certificate issued by competent authority (Authorised to issue such a certificate but not below the rank of a Tahsildar) b. OBC: Category I, IIA, IIB, IIIA and IIIB: As notified by the Karnataka Govt. Caste and Income Certificate issued by Tahsildar or higher revenue jurisdictional authority authorised to issue such a certificate. c. MINORITY: Religious (Christian) of All India / Linguistic (Tulu/Telugu/Konkani) of Karnataka minority candidates to produce certificate as per Annexure-4 of Brochure. Candidates who have not produced appropriate supporting documents for claiming the status of Religious / Linguistic Minority / SC / ST / OBC are liable to be considered as General Merit Candidates. Note: Kindly send the Application form and the enclosures in A4 size cover only. Avoid stapling of Demand Draft to the application form. Instead use clips. Application form must have candidate's signature, left forefinger impression and Parent/Guardian's Signature. Applications without the specified enclosures mentioned above will be REJECTED without prior intimation to the candidates and the application fee will not be refunded. Do not Sign and no attestation is required on the photograph. Please take a print of both COMEDK and Candidate copies of Date of Birth Certificate. Printed online COMEDK Copy of Date of Birth Certificate /Identity Proof is mandatory for processing the Application form. Printed online Candidate Copy of Date of Birth Certificate /Identity Proof is required to be carried during the Test Day as part of your Identity Proof. The completed Application Form with all the enclosures mentioned above should reach COMEDK office by speed post or courier on or before 15th April 2013(Monday) to the following address. Executive Secretary - COMEDK, # 132, Second Floor, 11th Main, 17th Cross, Malleswaram, Bangalore 560055, Karnataka. Phone:080-41132810

Print this Application

Print Date of Birth Certificate

https://www.comedk.org/main/UGET/UG_PrintApplication.aspx

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