BDS Admission From

Name of the Applicant

Expansion of Initials

Date of Birth

Age as on 31st December

Sex M/F

Recent Passport Size Photograph

Mobile No

E-mail ID

Blood Group

Nationality

Aadhar No

Religion

Caste

Mother Tongue

Father's Name

Educational Qualification

Occupation

Whatsapp No

Mobile-Adhar Linked

E-mail

Mother's Name

Mobile

E-mail

House Name

Post

Street

District

State

Country

Local Guardian's Name

If the Student is residing out Side EKM DIST, Should provide details of a Local Guardian

Local Guardian's Ph.No

Whether Hostel facility required

If No, place of stay

Outside Hostel, Name of Hostel

Warden No

Licence No

Migration Certificate No

Date

Name of the school last attended and year of study

YesNo

Eligibility Certificate (if applicable)

Board/University

Month & Year of passing

Reg No

Subjects

Max. Marks

Marks Obtained

Percentage

Physics

Chemistry

Biology

English

Maths

Total PCB Marks

Total Marks

Name of Examination

Authority

Application No

Roll No

Rank No - All India (overall)

Rank No - Category PH Rank

Percentile Score

Total Marks

Year

Roll No

Rank No

Date of allotment memo

Category(SM,SC,ST,OBC,OEC,EZ,MU,BH,NRI ETC)

BDS Admission Form

Fill up all details in block letters Application which is not complete in all respects is likely to be rejected

Educational Qualification Plus 2

NEET Details

KEAM Details

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