APPLICATION FORM FOR COMEDK UGET-2010
For those intending to apply to member institutions seeking admissions to
1st Year MBBS/BDS/BE for the year 2010-2011
-----------------------------------------------------------------------------------------------------------------
Read Instructions carefully before filling the form
1. Applicant Name    
2. Date of Birth         
3. Test Location Choice  
4. Course Applying for   
5. Gender   
6. Nationality  
7. Belongs to   
By Birth / Domicile  
8. Category  
OBC   
Minority     
9.
Address Line 1 
 
 
     Line 2   
 Line 3   
10. City    
If Others    
11. State  
12. Pincode      
13.  Phone No. with STD Code    
14. Mobile No.      
15. Email ID  
16.

Parent's / Guardian's Name

    
17. Payment Details DD Amount   Rs. ---/-
   DD No.       
 Drawee Bank   
 
If Others     
18. Name of Institution Last Studied    
19. Place of Institution Last Studied    
20. Year of Passing  
 
app_sample