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ApplicationformUG 2013

This 3 sentence summary provides the key details from the 2 page application form for registration to undergraduate medical courses (MBBS and BDS) at the Institute of Medical Sciences, Banaras Hindu University for the year 2013: The form requests information such as the candidate's personal details, category for admission, address, educational qualifications, and a declaration agreeing to the rules and regulations for application. The completed form with supporting documents and application fee must be submitted by April 15, 2013 to apply for admission to the undergraduate medical programs offered at the Institute of Medical Sciences.

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40 views

ApplicationformUG 2013

This 3 sentence summary provides the key details from the 2 page application form for registration to undergraduate medical courses (MBBS and BDS) at the Institute of Medical Sciences, Banaras Hindu University for the year 2013: The form requests information such as the candidate's personal details, category for admission, address, educational qualifications, and a declaration agreeing to the rules and regulations for application. The completed form with supporting documents and application fee must be submitted by April 15, 2013 to apply for admission to the undergraduate medical programs offered at the Institute of Medical Sciences.

Uploaded by

alexander-hunt
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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INSTITUTE OF MEDICAL SCIENCES

BANARAS HINDU UNIVERSITY


VARANASI-221005

NEET (UG) Registration No.

APPLICATION FORM FOR REGISTRATION OF ADMISSION TO UG COURSES (MBBS & BDS) -2013
Last date for completed form to reach to the office of the Director, Institute of Medical Sciences, BHU : 15.04.2013
THIS FORM CO TAI S TWO PAGES TO BE FILLED BY THE CA DIDATE Candidates are advised to read the instructions carefully before filling up the registration form

(For Office Use Only) Provisionally allowed/Not allowed BHU Reg. No. Important i) Last date for receipt of completed form by Registered / Speed Post to the office of the Director, IMS, BHU, Varanasi-221005 is 15.04.2013 ii) This form contains Two pages to be filled by the candidate. iii) The application form must be signed by the candidate wherever indicated. (To be filled in by the candidate in his/her own handwriting) Tick ( ) the appropriate box Details of Demand Draft enclosed of Rs. 1000/ (General & OBC), Rs. 600/- (SC & ST) DD No Bank Name 2. 3. 4. 5. 6. 7. 8. 9. Course applied for : MBBS Date Issuing Branch BDS Amount Payable at Date of Receipt Diary No. / Receipt No.

Name of the candidate (IN BLOCK LETTERS) ___________________________________________ Father's Name ________________________________________________________________ Mothers Name _______________________________________________________________ Date of birth Day_____________ Month______________ Year __________________ 8. State_______________________
Paste recent photograph duly attested by the Principal of the Collage / Gazetted Officer

Nationality________________________ Sex Male Female

Category* under which admission is sought General SC ST OBC Physically Challenged (PC)

10.

Address for Communication ____________________________________________________ _______________________ City _____________________________District_____________________________State ___________________________ Pin _________________Tel. No. with STD Code /Mobile _____________________e-mail___________________________

11.

Permanent Address ___________________________________________________________ _______________________ City _____________________________District_____________________________State ___________________________ Pin _________________Tel. No. with STD Code /Mobile _____________________e-mail___________________________

* SC/ST Candidates must attach attested copy of Caste Certificate in support duly attested by a Gazetted Officer and OBC (Other Backward Classes/PC (Physically Challenged) candidates must attach a copy of recent relevant Certificate duly attested by a Gazetted Officer.

12. Details of the Examinations Passed Name of the Examination University/ Board Year Marks obtained Maximum marks % of Marks No. of Attempts

High School/ or equivalent I.Sc. or equivalent of 10 +2 level/appearing

DECLARATION I declare that I have read the instruction and registration form, and all the information furnished by me are true. I declare that I fulfill the minimum eligibility required to appear at the entrance test. I have neither completed nor continuing MBBS/BDS course from anywhere. In case any information furnished above by me is found wrong at any time, my candidature for the examination/ selection to the course may be cancelled outright and I may be debarred permanently from the admission and disciplinary action may be taken against me. I declare that I am an Indian National, have not taken part in any activity subversive of law and have not been debarred by the University / Institution for seeking admission. Date Place Signature of the Candidate

Please visit www.bhu.ac.in for detailed advertisement and important dates.

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