Hind Institute of Medical Sciences, Lucknow

Form Cost: Rs. 1000/-

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Personal 1
Personal 2
Education 1
Education 2
Declaration
Documents

Personal 1

Your Name *

Course Applied *

Email *

Mobile Number *

Date of Birth *

Nationality *

Father's Name *

Father's Occupation

Mother's Name *

Mother's Occupation

Guardian's Name

Guardian's Occupation

Personal 2

Address *

City *

PIN Code

Country *

Were you ever disqualified by any University / Board to appear in any examination? *

If yes, please specify the details

Education 1

Class 10th Board Name *

Class 10th Subjects Name *

Class 10th Year of Passing *

Class 10th Marks (in %) *

Class 12th Board/University Name *

Class 12th Subjects Name *

Class 12th Year of Passing *Expected year, if not already graduate

Class 12th Marks (in %)

Graduation University Name

Graduation Subjects Name

Graduation Year of Passing

Graduation Marks (in %)

Education 2

Post Graduation Board/University Name

Post Graduation Subjects Name

Post Graduation Year of Passing

Post Graduation Marks (in %)

Other Board/University Name

Other Subjects Name

Other Year of Passing

Other Marks (in %)

Declaration

I have read and understood the eligibility criteria conditions as laid by the prospectus. I fulfill this criteria. I have furnished the necessary information correctly. I shall submit any document that may be required in future. I understand that my criteria is liable to be cancelled by Hind Institute the information given by me in this form is found incorrect or misleading. The University has full authority to take appropriate action and I shall abide by the university action.

* Yes

Documents

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