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PGET 2016
Application Form For Admission To MD / MS (UNANI) Course 2016 - 17
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Personal Details
Name
*
:
( as per 10th marks card )
Date of Birth
*
:
Gender
*
:
Male
Female
Category
*
:
Nationality
*
:
Whether Physically Disabled:
Yes
No
Whether GOI Nominee :
Yes
No
Whether Govt.In-Service Candidate :
Yes
No
Domicile State
*
:
Mother's Name
*
:
Father's Name
*
:
Communication Address
*
:
Permanent Address
*
:
Mobile No.
*
:
Alternate Mobile No. :
Phone No.with STD Code
*
:
Email ID
*
:
Details of Qualifying Examination
College
*
:
University
*
:
Date of Completion of Internship
*
:
( should be on or before 09/09/2016 )
Examination
Maximum Marks
Secured Marks
Percentage
No. of Attempts
(should be >= 1)
Passed Month
(Example Apr 2013)
Details of Fee
Challan No
*
:
Date
*
:
Amount
*
:
Name of the Bank
*
:
Branch Name with Place
*
:
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