KCPCMF : MEDICAL ADMISSION AUTOMATION SYSTEM                           

KCPCMF - ONLINE APPLICATION FORM FOR ADMISSION TO PG DENTAL (MDS) COURSE 2017
Name of the Applicant*
(As entered in 10th certificate)
 
Gender*   Male      Female
Nationality  
Religion and Caste* Religion :           Community/Caste :     
Category  (General,PH,OBC,SC,ST)
Date of Birth* DD -MM -YYYY
Name of the Parent/Guardian*         Relation:
Address
 Permenant Address    Communication Address*
     
Phone No*  Res with STD :           Mobile :
Email Address*
(Active valid E-mail ID)
 
Details of the Qualifying Examination (BDS)* Name of the Dental College
Name of the University
Year of passing BDS
Marks obtained in Qualifying Examination*  
Phase Subject Total Marks Marks Obtained % of Marks No of Chances
1 BDS          
         
         
         
         
         
         
2 BDS          
         
         
         
         
         
         
3 BDS          
         
         
         
         
         
         
4 BDS          
         
         
         
         
         
         
Total        
Details of the Internship (C.R.I.) Training:
Date of Training         From         To

Name of the Institution

Name of the State Dental Council

the applicant is Registered & Registration No.

Details of Diploma Courses, if any: Name of the Dental College

Name of the University

Year of passing Diploma

Subject Total Marks Marks Obtained % of Marks No of Chances
      %  
      %  
      %  
      %  
Details of the Entrance Test Qualified:*
(N.B.: Attach a copy of the Printout of the relevant Result(s)) )
ALL INDIA Post Graduate Dental (MDS) Entrance Examination (NEET 2017) General Merit List Details
Testing ID Score Obtained (up to fourth decimal) Maximum Score Percentile (%) All India NEET Rank
         
Declaration of the Applicant
          I hereby declare that all the information furnished above is true to the best of my knowledge and belief. If selected, I promise to abide by the rules and regulations of the institution. I promise to submit all the certificates and documents in original at the time of admission and pay the fees as specified in the prospectus, failing which the admission will be liable for cancellation.