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FORMAT OF APPLICATION
VOKKALIGARA SANGHA DENTAL COLLEGE & HOSPITAL
(Affiliated to the RGUHS, Karnataka & Recognized by DCI New Delhi)
VOKKALIGARA SANGHA (Regd.) BANGALORE
Visveswarapura, Krishnarajendra Road, Bangalore-560 004
Ph. 26618066 Tele Fax : 26526705
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Affix recent pass port size photo
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APPLICATION FOR ADMISSION TO BDS COURSE
THROUGH COMEDK-UGET 200_______200_______
Appln. No
.. COMEDK RANK No
1, Name of the candidate : ______________________________________
(In capital letters)
2. Sex (Male/Female) : ______________________________________
3. Fathers Name : ______________________________________
4. Date of Birth & Age as on 31st Dec. : ______________________________________
5. Domicile : _______________________________________
6. Address for correspondence : _______________________________________
& Tel No. & Mobile No.
______________________________________
_____________________________________
7. Permanent Address : ______________________________________
& Tel.No. & Mobile No.
_____________________________________
______________________________________
8. Religion & Nationality : ______________________________________
9. Caste : ______________________________________
10. If SC/ST/BCM/Sports-give : ______________________________________
Particulars (Enclose Certificate)
11. Educational Data of Applicant
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Name and Address of
The Schools/Colleges
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Classes
Studied
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DURATION
From To
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Primary
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Middle
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High School
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12. Produced the Eligibility certificate for
admission as per RGUHS
regulations. : ________________________________
13. RESULTS
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COMED-K for year 200____
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Application No.
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COMED-K
Registration No.
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COMED-K
Rank. No
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Karnataka Candidates
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Non-Karnataka Candidates
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14. MARKS OBTAINED IN QUALIFYIING SUBJECT MAXIMUM MARKS
EXAMS II PUC OR ITS EQUIVALENT: MARKS OBTAINED
(attach Xerox copy of marks card)
PHYSICS
CHEMISTRY
BIOLOGY
ENGLISH_____________________________
TOTAL
_______________________________________
Percentage
______________________________________
DECLARATION
I declare that the above Particulars are true and correct to the best of my knowledge and belief. In case the above Particulars are found to be incorrect, my application for admission is liable to be cancelled and fee forfeited.
Signature of the Applicant
Place:
Date:
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FOR OFFICE USE
The applicant
.has been given provisional Admission to
B D S course for the academic year 200
-200
Fee D.D No
And Date
..Amount
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CASE WORKER CASHIER MANAGER PRINCIPAL
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NOTE: A copy of application to be sent to the following address Member Secretary, Committee for overseeing the entrance test conducted to association of private professional colleges. CET cell premises, Ist Floor, 18th cross, Sampige Road, Malleswaram, Bangalore-560 003.
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