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9/16/13

BCECE Board, Patna

BIHAR COMBINED ENTRANCE COMPETITIVE EXAMINATION BOARD


Application Form for Under Graduate Medical Admission Counselling 2013 for admission to MBBS/BDS on the Basis of NEET (UG) - 2013 (for 2nd Counselling) PART-A

1. Roll No.: 2. Score : 3. All India Rank: 4. State Rank (for Bihar): 5. State Category Rank (for Bihar): 6. Name of the Candidate: 7. Father's Name: 8. Date of Birth: 9. Gender: 10. Category: 11. Mobile No.: 12. Do you claim Disable Quota (DQ): 13. Are you permanent resident of Bihar: 14. Challan Details

81110854 189 137083 11502 527 ANJALI MIT SHASHI KANT PASWAN 30/12/1994 FEMALE SC 8271795851 NO YES

Registration No. (Office use only) 10032346 Paste (Do not staple) Paste Passport size photograph of the candidate, identical to one as used for preparing Admit Card of NEET (UG)-2013

(i) Journal No.: 025147099 (ii) Application Fee Amount: 225 (iii) Deposit Date: 16/09/2013
Countersignature of Father/Mother/Husband/Guardian

Date : ........................

Full Signature of the Candidate (in Hindi)

Full Signature of the Candidate (in English)

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