Course :
Name of the Candidate :
Father’s / Guardian’s Name :
Date of Birth:
Place of Birth :
Permanent Address of the Candidate : :
Correspondence address of the Candidate :
Phone No.:
WhatsApp No. :
Email ID.:
Nationality :
Religion:
Caste :
Occupation of Father / Guardian :
Annual Income of Father / Guardian : :
Education qualification :
Have you suffered from any serious illness in the past :
If so, what were you suffering from :
Have you undergone any surgery:
If yes, what is the nature of surgery :
Candidate’s Photo:
Candidate’s Signature:
I wish to apply for admission to Shyamlal Chandrashekhar Medical College, Khagaria and declare that I have filled this form myself and to best of my knowledge and belief, the above particulars are true.
I have gone through the instructions for admission carefully and undertake to abide by all the conditions. I further agree, if admitted, confined to the rules and regulations at present in force or that may hereafter be made for the administration of the College and hostel. I undertake that as long as I am a student of the College and hostel. I will do nothing unworthy as a student of the College either inside or outside or anything that will interfere with its orderly working and discipline. I am aware that the management has the full authority to expel me for disinterest in studies, misbehavior and continuous failures.
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