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    Application Form For Comedk Uget

    Uploaded by

    Sarang Srivastav
    This document is an application form for COMEDK UGET-2011, which is an entrance exam for admissions to engineering and medical programs. It contains details of an applicant such as name, date of birth, address, category, parents' income, payment details, educational qualifications and a declaration signed by the applicant. The document also lists the required documents to be submitted along with the application form such as a demand draft, photo identity proof, class 10 marks card and caste/category certificates if applicable. It provides instructions regarding filling the form correctly and the deadline to submit the completed application.

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    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd

    Application Form For Comedk Uget

    Uploaded by

    Sarang Srivastav
    57 views3 pages
    This document is an application form for COMEDK UGET-2011, which is an entrance exam for admissions to engineering and medical programs. It contains details of an applicant such as name, date of birth, address, category, parents' income, payment details, educational qualifications and a declaration signed by the applicant. The document also lists the required documents to be submitted along with the application form such as a demand draft, photo identity proof, class 10 marks card and caste/category certificates if applicable. It provides instructions regarding filling the form correctly and the deadline to submit the completed application.

    Original Title

    APPLICATION FORM FOR COMEDK UGET

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    © Attribution Non-Commercial (BY-NC)

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    This document is an application form for COMEDK UGET-2011, which is an entrance exam for admissions to engineering and medical programs. It contains details of an applicant such as name, date of birth, address, category, parents' income, payment details, educational qualifications and a declaration signed by the applicant. The document also lists the required documents to be submitted along with the application form such as a demand draft, photo identity proof, class 10 marks card and caste/category certificates if applicable. It provides instructions regarding filling the form correctly and the deadline to submit the completed application.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    57 views3 pages

    Application Form For Comedk Uget

    Uploaded by

    Sarang Srivastav
    This document is an application form for COMEDK UGET-2011, which is an entrance exam for admissions to engineering and medical programs. It contains details of an applicant such as name, date of birth, address, category, parents' income, payment details, educational qualifications and a declaration signed by the applicant. The document also lists the required documents to be submitted along with the application form such as a demand draft, photo identity proof, class 10 marks card and caste/category certificates if applicable. It provides instructions regarding filling the form correctly and the deadline to submit the completed application.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    APPLICATION FORM FOR COMEDK UGET-2011

    For those intending to apply to member institutions seeking admissions


    to 1st Year MBBS/BDS/BE for the year 2011-2012

    __________________________________________________________________________________________
    ___________

    Application Number: 114278


    Applicant Name: VIVEK KUMAR SRIVASTAVA
    Date of Birth: 03/07/1992
    Test Location Choice: BANGALORE
    Course Applying for: BE
    Please affix your
    Gender: MALE recent passport size
    Nationality: INDIAN colour photograph
    Belongs to: NON-KARNATAKA here
    By Birth / Domicile:
    Category: GM

    Parents Annual Income: 600000.00


    Address: 202/A,DAIRY COLONY,
    NEAR LOCO SPORTS GROUND
    GORAKHPUR-273012,UTTAR PRADESH
    City: GORAKHPUR 
    State: UTTAR PRADESH
    Pincode: 273012
    Phone No.: 05512283075 Mobile No.:   09956399663
    Email ID: [email protected]
    Parent's/Guardian's Name: VIJAY KUMAR SRIVASTAVA
    DD No.:  958953 DD Amount:  Rs.800/-
    Payment Details:
    DD Date  23/03/2011
    Drawee Bank: STATE BANK OF INDIA
    Name of Institution Last Studied: ST. JOSEPHS SCHOOL

    Place of Institution Last Studied: GORAKHPUR

    Year of Passing: 2010


     
    Declaration: I hereby declare that the particulars given in this form are true to the best of my knowledge &
    belief.
         Date:                                                                 Place:                                                    

     
    Please send the following along with the completed Application Form: 

    1. Demand Draft drawn in favour of "COMEDK" (check for the correct spelling), payable at


    Bangalore (DD must be payable at Bangalore only) for Rs.800/- (Eight Hundred Only)
    3 subjects (PCM or PCB) for MBBS/BDS or B.E and Rs.1000/- (One Thousand Only)
    subjects (PCMB) for MBBS/BDS and B.E. 
    Application number, applicant’s name & contact Number to be written at the back of the Demand
    Draft. Check for the banker’s signature on the Demand Draft.
    2. Printed Online Application Form
    The completed application form must have
     Candidate’s photo should be pasted (within the box provided)
     Candidate’s signature (within the box provided)
     Left forefinger impression of the candidate (within the space provided)
     Candidate’s parent/guardian’s signature (within the box provided)
    3. Printed Online Date of Birth Certificate / Identity Proof (COMEDK copy).
    The completed Date of Birth Certificate / Identity Proof must have
     Attestation (within the space provided) by the Head of the Institution where he/she last
    studied or Gazetted officer not below the rank of Tahsildar of the area in which he/she is a
    resident.
     Candidate’s photo should be pasted (within the box provided)
     Candidate’s signature (within the box provided)
    4. 10th Standard Marks Card.

    Candidates belonging to SC / ST of All India and OBC of Karnataka would be considered,


    provided they furnish the Photocopy of the following Certificates:

    a. SC / ST: Caste Certificate issued by competent authority (Authorised to issue such a certificate


    but not below the rank of a Tahsildar)
    b. OBC: Category I, IIA, IIB, IIIA and IIIB: As notified by the Karnataka Govt. Caste and Income
    Certificate issued by Tahsildar or higher revenue jurisdictional authority authorised to issue such a
    certificate.
    c. MINORITY: Religious (Christian) of All India / Linguistic (Tulu/Telugu/Konkani) of Karnataka
    minority candidates to produce certificate as per Appendix–IV of Brochure.

    Candidates who have not produced appropriate supporting documents for claiming the status of Religious
    / Linguistic Minority / SC / ST / OBC are liable to be considered as General Merit Candidates.
    Note: 
     Kindly Send the Application form and the enclosures in A4 size cover only.
     Avoid stapling of Demand Draft to the application form. Instead use clips.
     Application form must have candidate's signature, left forefinger impressions and
    Parents/Guardian Signature.
     Applications without the specified enclosures mentioned above will be REJECTED without prior
    intimation to the candidates and the application fee will not be refunded.
     Do not Sign and no attestation is required on the photograph.
     Please take a print of both COMEDK and Candidate copies of Date of Birth
    certificate.

     Printed online COMEDK Copy of Date of Birth Certificate /Identity proof is


    mandatory for processing the Application form.
     Printed online Candidate Copy of Date of Birth Certificate /Identity proof is
    required to be carried during the Test Day as part of your identity proof.

    The completed Application Form with all the enclosures mentioned above should
    reach COMEDK office bySpeed post or courier on or before 19th April
    2011(Tuesday) to the following address.
    The Executive Secretary - COMEDK,
    # 132, Second Floor, 11th Main,
    17th Cross, Malleswaram, Bangalore 560055,
    Karnataka. Phone:080-41132810
       

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