पंडित दीनदयाल उपाध्याय स्मृति स्वास्थ्य विज्ञान एवं आयुष विश्वविद्यालय छत्तीसगढ

( पूर्व नाम छत्तीसगढ आयुष एवं स्वास्थ्य विज्ञान विश्वविद्यालय )

EXAMINATION FORM

Exam Details
Name of M.B.B.S. SECOND YEAR
(MAIN EXAM) - FEB 2024 Application No. EXAM-0077531
Examination
Enrollment Details
College Name LT. LAKHIRAM AGRAWAL MEMORIAL GOVT. MEDICAL COLLEGE, RAIGARH, RAIGARH
BACHELOR OF MEDICINE
Year of Admission 2021 Course Name AND BACHELOR OF SURGERY
(M.B.B.S.)(YEAR 2)
Batch 2021-2025 Exam Status REGULAR

Enrollment No M-1/05015 Roll No 22010487

Personal Details
Name of Candidate AJAY SINGH Date of Birth 21/Mar/1999

Father's Name PRABHAKAR SINGH Mother's Name KIRAN SINGH

Present Address WARD NO. 05 DABARI PARA LORMI District MUNGELI Pin Code 495115

Permanent Address WARD NO. 05 DABARI PARA LORMI District MUNGELI Pin Code 495115
Mobile Number 9893574727 Email Id ajaysingh21399@gmail.com

Gender MALE Caste/Category GENERAL

Nationality Indian Adhaar No

(1)PATHOLOGY - I(2)PATHOLOGY - II(3)PHARMACOLOGY - I(4)PHARMACOLOGY -
Subjects II(5)MICROBIOLOGY - I(6)MICROBIOLOGY - II
Document Uploaded

Requirement Uploaded
Document Name
Type Status
10th Marksheet Required Uploaded
12th Marksheet Required Uploaded
ID Proof (pan card/driving license/ Voter ID/ Passport / other) Required Uploaded
Enrolment Slip/Acknowledgement (If you are not having then
Required Uploaded
kindly write a declaration in plain paper and scan- upload it)
Declaration
मेरे द्वारा ऊपर भरा गया विवरण सही है | कोई बात असत्य पाई गयी तो उसकी पूर्ण जिम्मेदारी मेरी होगी और धोखाधड़ी करने के दंडनीय अपराध की सजा मै
स्वीकार करूँ गा / करुँ गी | मैं पंडित दीनदयाल उपाध्याय स्मृति स्वास्थ्य विज्ञान एवं आयुष विश्वविद्यालय छत्तीसगढ़ के द्वारा ली जाने वाली परीक्षा में आवेदन
करता/करती हूँ |
Date Signature of Candidate

Forwarding
I certify that AJAY SINGH Father PRABHAKAR SINGH is REGULAR Candidateof the college and he/she is eligible
to appear in M.B.B.S. SECOND YEAR (MAIN EXAM) - FEB 2024.All the Certificates and terminals have been
checked by me and I certify that the information given by the candidate is true.
Date Signature & Seal of Principal