KLE UNIVERSITY - PGAIET - 2009 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.
Candidate Details
Candidate's Name :(As given in class SSLC/10th Certificate)	^*
Father's/Mother's Name :	^*
Gender :	Male Female ^*
Date Of Birth :	^* [eg: DD/MM/YYYY]
Address for Communication:	^*


CITY
PIN :	^*
District
STATE
E-Mail :	^*
Telephones :
STD Code	^*
Telephone	^*
Mobile
Choice Of Centre :	^*
Category :	General Merit BRD KTC ^*
Course intending to apply :	Medical Dental ^*
Details of Demand Draft :
D. D. No.	^*
Amount in Rs	^*
Date Of Issue	^* [eg: DD/MM/YYYY]
Name of Drawee Bank	^*
Will you download TAT card online ?	YES NO ^*
Details of Education :	M.B.B.S B.D.S ^*
Name of University	^*
Name of College	^*
Month/Year of Passing :	/ ^*
Month/Year of Internship completion/completing : Should complete internship by 30/04/2010	/ ^*
Please enter the percentage of Marks scored in MBBS / BDS ( Please don't enter % Symbol)
Percentage MBBS-1 / BDS-1
Attempts MBBS-1 / BDS-1
Percentage MBBS-2 / BDS-2
Attempts MBBS-2 / BDS-2
Percentage MBBS-3 / BDS-3
Attempts MBBS-3 / BDS-3
Percentage MBBS-Final / BDS-Final
Attempts MBBS-Final / BDS-Final
Aggregate Percentage
Total attempts
15. 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 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 KLE PGAIET - 2010 will be in the courts of Belgaum.