Online Application Form




Details of Parents/Guardian

Father Mother Guardian
Name
Occupation
Address (Use Pin code)
Tel. No.
Mob.No
Email
Income

Qualifications (+2)

Name of the Qualifying Examination
Name of University / Board
Register No Year of Passing
Subject Physics Chemistry Biology Maths Bio-Tech Comp.Sci. Total
Marks obtained
% of Marks obtained
Medium of Instruction

Details of NEET Examination

2018 Roll No./Application No.
Marks Obtained
Physics (Out of 180) Chemistry (Out of 180) Biology (Botany & Zoology (Out of 360))
Total (Out of 720) Percentile Score NEET All India Rank

Details of KEAM

2018 Roll No./Application No. 2018 Qualifying Mark Are you KEAM Eligible

Other Information

Name and address of the School / College Last attended
Whether the candidate was a member of Sports / NCC / NSS / Arts others (Enclose copy of certificates)

Enclosure: attested copies of:-
Certificate and Mark list of the Qualifying Examination, Entrance Rank Certificate, GRADE 10 Certificate in proof of age, Caste and Community Certificate, Course and conduct certificate from the institution last attended, Transfer Certificate (in case not enclosed should be produced at the time of Admission) Any other relevant certificate in proof of any claim made in the Application.


Declaration by the Applicant

Declaration by the Parent/Guardian