APPLICATION FORM (Kindly take Print out of the form or save it as Word  File)

                                           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

Affix recent pass port size photo

 

    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.   Father’s 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

Name and Address of

The Schools/Colleges

Classes

Studied

DURATION

From                         To

 

Primary

 

 

 

Middle

 

 

 

High School

 

 

                                                                               

                                                                                                                                                                               

 

 

                                                                        - 2 -

12. Produced the Eligibility certificate for

      admission as per RGUHS

      regulations.                                                   :     ________________________________

 

13.  RESULTS

 

COMED-K for year 200____

Application No.

COMED-K

Registration No.

COMED-K

Rank. No

Karnataka Candidates

 

 

 

 

Non-Karnataka Candidates

 

 

 

 

 

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:

 

 

 

 

 

 

 

 

 

 

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 …………………………..

 

 

CASE WORKER                  CASHIER                 MANAGER                PRINCIPAL

 

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.