Application Form

Name*

Date of Birth*

Age*

Gender* —Please choose an option—MaleFemaleOther

Nationality*

Passport Number

Passport Expiry Date

Present Mailing Address*

Permanent address same as mailing address:

Permanent Address*

Phone Number*

Email*

How did you know about this MBBS program?* —Please choose an option—Referrer/LecturerConsultantWebsiteInstagramFacebookTwitterYoutubeFriend/FamilyGoogleAdvertisementNewspaperRadioOther

If referrer/lecturer or consultant, please specify their full-name/mobile/email:

Name*

Nationality*

Profession*

Phone Number*

Email*

SSC or Equivalent Board

Year of Passing*

Marks Obtained*

Total Marks*

Board/Institution*

Honours, Medals, Positions, or Scholarships

SSC (10th) Certificate*

Inter (12th) Scorecard*

NEET Scorecard*

Name of Applicant*

Attach Applicant’s Photo*

Passport Copy