M.S.

RAMAIAH MEDICAL COLLEGE & HOSPITALS

M.S.R.Nagar, MSRIT Post, MATHIKERE, BANGALORE 560054.
Phone-+91-80-2360 5190, 2360 1742, Fax-+91-80-2360 6213. Email: msr_medical@dataone.in / msrmedical@gmail.com Photo

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Application form for selection to MBBS course Under Management Quota for ( NRI / FOREIGN Candidates ) for the Academic Year 2012-13 NAME OF THE APPLICANT (as written in 12th Marks card) Mr / Miss. ___________________________________________ Mobile No. Name of Father Mobile No. Name of Mother Mobile No. Annual Income of Parent Rs. Complete address for communication.

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Phone No .with std code. Fax, Email ID Nationality Religion : Name of the Qualifying Examination passed .{10 + 2 } Name of the School / College District & State. Date of Birth (should have completed 17 years
of age as on Dec 2012 i.e., born before 31.12.1995)

Fax Indian / NRI / Foreign National. () {Tick} Hindu / Christian / Muslim / Sikh _______(nationality)
II PUC / CBSE / ISC / ICSE / HSC / Pre-Medical / High School Diploma/ A- Level / Edexcal / STPM/Ontario Diploma/ ....{tick}

Reg. No Month Year of passing .

.. (DD)

..(MM)

...(YY)

Age: Years

Subject a] First Language English Subject b] Marks Obtained In the optional Subjects Physics Chemistry Biology /

Max Marks ______ Max Marks . . _________

Marks Obtained ______ Marks Obtained .. _______ ________

Percentage _____ % Percentage .. .. .. ________ ________

Total _________ Dated .

Signature of Candidate

Signature of Parent.

Eligibility Criteria: Pass in 12th Std. with 50% aggregate Marks in Physics, Chemistry & Biology/Biotechnology & Pass in English

Enclosures: Xerox copy of I A} 12th Std Marks Card, B}Date of Birth. Proof Certificate / C) Conduct Certificate, D) High School Diploma Certi., E) Accreditation Certificate. F) Numerical conversion of Grades G) Passport Copy VISA Copy OCI Copy / POI Copy / etc,

M.S.RAMAIAH MEDICAL COLLEGE

M.S.R.Nagar, MSRIT Post, MATHIKERE, BANGALORE 560054.
Phone-+91-80-23605190, 23601742, Fax-+91-80-23606213. Email: msr_medical@dataone.in / msrmedical@gmail.com PHOTO

Application form for selection to MBBS Course Under Management Quota for ( NRI Sponsor Seats) for the Academic Year 2012-13

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NAME OF THE APPLICANT ( as written in 12th Marks card ) Mobile No. Name of Father Mobile No. Name of Mother Mobile No. Annual Income of Parent Complete address for communication.

Mr / Miss. ___________________________________________

Rs.

Phone No .with std code. Fax, Email ID

5. 6. Nationality Religion : Name of the Qualifying Examination passed .{10 + 2 }

Fax
Hindu / Christian / Muslim II PUC / CBSE / ISC / ICSE / HSC / Pre-Medical / High School etc....{tick} Reg. No.. Month..Year of passing ..

7. 8. 9.

Name of the School / College District & State.

Date of Birth (should have completed 17 years

of age as on Dec 2012 i.e., born before 31.12.1995)

.. (DD) Subject English Subject Physics Chemistry

..(MM)

...(YY)

Age: Years. Percentage _____ % Percentage .. % .. %

a] First Language b] Marks Obtained In the optional Subjects

Max Marks ______ Max Marks .

Marks Obtained ______ Marks Obtained . .... _______

Biology / Biotechnology . __ _______ Total 10.

COMDEK- UGET-2012 TAT NO
Fill up this column if you have appeared for entrance exam) Eligible to apply if obtained more
than 50%

.. % ________ %

Rank Obtained.Scores

(Enclose copy)

Score

11.

KEA CET-2012 TAT No...

(For Karnataka students ) (Fill up this
column if you have appeared for entrance exam) Eligible to apply if obtained more than 50% Score

Rank ObtainedScores

(Enclose copy))

Eligibility Criteria: Pass in 12th Std. with 50% aggregate Marks in Physics, Chemistry & Biology/Biotechnology & Pass in English as well as completion of 17 years of age as on December 2012 th Enclosure: Xerox copy of A} 12 Std Marks Card, B}Date of Birth Proof Certificate C) Character .Certi NRI-SPONSOR ELIGIBILITY CRITERIA:-Sponsorship letter from Sponsoring family members / cousin which is to be Notarized abroad or attested by Indian embassy abroad- Encl:- Proof of Supportive documents for NRI Status Passport copy / VISA / NRI Bank A/C No etc., + in addition you have to pass any one Common Entrance Exam- K.E.A.CET-2012 OR COMEDK UGET-2012.which is mandatory to be eligible for admission.

Dated .

Signature of Candidate

Signature of Parent.

DECLARATION BY THE SPONSORING RELATIVE

(FOR ADMISSION UNDER NRI CATEGORY SEATS)
I, ___________________________________________Son of Sri/Dr. __________________________
(Name of Sponsor)

Aged _________years (Date of Birth

______________) holding an __________________________ Passport

bearing No.____________________________ residing at_____________________________ _______________________________________________________________________________ ______________________________________________________________________________ Tel. No. _______________________________________ Mobile No. ________________________ Email ID ________________________________________________________________

I do here solemnly affirm and state that: Mr./Ms.___________________________________________________________________ who is seeking admission to M.B.B.S course at M.S. Ramaiah Medical College is my Son/Daughter/ Cousin/ Close relative. I would wish to state that I shall be sponsoring the said student for the MBBS course.

Passport Details:
Passport No. _______________________ Place of Issue _________________________

Date of Issue _______________________ Date of Validity of Passport _________________ BANK ACCOUNT DETAILS Nature of Account _________________________________ Name of the Bank & Address _________________________ Relationship with the student _________________________

(SIGNATURE OF THE SPONSORER) Place: ____________________________ Date: _____________________________ Enclose: Xerox copy of passport, VISA or Bank Account Passbook or Residential permit or Employment Certificate. Sponsoring letter to be attested by Notary abroad or attested by Indian embassy abroad.