KLE UNIVERSITY -KLEU - AIET - 2012 APPLICATION FORM

Applications submitted more than once will be rejected Please fill the application and click on submit button, then you will get a preview screen, in that preview screen at the bottom you will get a button "Print this Form" Please click this button, you will get the print out, in that print out you will get space for sticking Photograph and Thumb impression. Note: Make sure your computer is connected to printer
Course Intending to apply	M.B.B.S B.D.S B.P.T B.Pharm BSc Nursing Post Certificate B.Sc Nursing BAMS ALL ^{* Selecting any one or all. The exam is common for all}
Candidate Details
1. Candidate's Name :(As given in class SSLC/10th Certificate)	^*
2. Father's Name :	^*
2. Mother's Name :	^*
3. Gender :	Male Female ^*
4. Date Of Birth :	^* [eg: DD/MM/YYYY]
5. Address for Communication:	^*


CITY
PIN :	^*
District
STATE
6. E-Mail :	^*
7. Telephones :
STD Code	^*
Telephone	^*
Mobile
8. Choice Of Centre :	^*
9. Category :	General Merit BRD KTC ^*
10. Details of Demand Draft :
D. D. No.	^*
Amount in Rs	^*
Date Of Issue	^* [eg: DD/MM/YYYY]
Name of Drawee Bank	^*
11. Educational Details :
Year of Passing SSLC / SSC / 10th :	^*
Persentage in SSLC / SSC / 10th :	^{* Please enter Persentage of Marks}
12. Appearing for PUCII / HSC / 12th :	YES NO^{*If appearing this year, Select YES. Already appeared select NO.}
Year of Passing PUC II / HSSC / 12th :	^* If appearing this year, Please put 2012.
13. Name of the PUCII / HSC / 12th Board :	^*
14. Declaration - I I hereby declare that the above information is true and complete to the best of my knowledge. I am aware that if any information herein is found to be incorrect or incomplete, my application form will be rejected / admission will be cancelled. If admitted to any of the college of KLE University, Belgaum I shall abide by its Rules &Regulations. I have read and understood all the provisions contained in the brochure / website and hereby agree to abide by these provisions. I am aware that, any legal matters arising out of the total admission process of any Course through KLEAIET - 2012 will be in the courts of Belgaum. I will not indulge in any kind of ragging activities.