Online Application Form

Name of the Candidate (in Block Letters):

Father's Name & Occupation:

Mother's Name:

Permanent Address:

Contact No.:

Parent's Contact No.:

Date of Birth:

Age:

Course Interested:

Academic Qualification:

Name of the School last attended:

If NEET appeared / Marks obtained:

Category: SCSTBCGEN

Yearly Income:

Enclosures

10th Marksheet :

+2 Marksheet :

NEET Score Card :

Certificate of proof of age (Aadhaar card or birth certificate) :

Conduct certificate from institution last attended :

Community certificate :

Migration certificate :

Transfer certificate :

Passport size photographs (5 Nos) :

I declare that the facts stated above are correct to the best of my knowledge and belief. I further declare that if admitted, I shall abide by the rules and regulation of the institution and as prescribed by Maharajas Institute of Medical Science.