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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
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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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- 2 -
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
..
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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