| 1.
|
Name
of the Applicant : __________________________________________ |
| . |
(
In capital letters) |
| 2.
|
Father's
Name : _________________________________________________ |
| 3.
|
Permanent
Home Address : ______________________________________ |
| 4. |
Address
for Communication : _____________________________________ |
| . |
EmailID:__________________________Contact Number:_______________ |
| 5.
|
Date
of Birth: ____________________________________________________ |
| 6.
|
Nationality
: ________________________ Sex ( Male/Female) :_______ |
| 7. |
Passport
No. : _______________________ Issued from :______________ |
| 8.
|
Type
of Visa :_________________________ Valid up
to : ____________ |
| 9.
|
Expected
date of arrival in India : _________________________________ |
| 10.
|
Date
of arrival and address in India : _____________________________ |
| . |
(If
you are in India) |
| 11.
|
Whether
self supporting or scholarship holder : ______________________ |
| 12.
|
Academic
Qualifications : ________________________________________ |
| 13.
|
Medical
Qualifications : __________________________________________ |
| 14.
|
Experience
in practice : __________________________________________ |
| . |
(if
having medical qualification/ profession) |
| 15.
|
Do
you need hostel accommodation : ____________________________ |
| . |
(Please
attach true copies testimonials/proof for 5,6,12,13) |
|
I hereby declare that the information given above is true. In case
I am selected for the course, I shall abide by the rules and regulations
of the University applicable to the course trainees and also the
laws in force in the country binding on foreign nationals.
|
| Date
: ____________ |
| Place
: ____________ |
Signature
of Applicant
|
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