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					                                    Christian Medical College, Vellore - 632002.
                              Online Application Form for SUMMER ADMISSIONS - 2012
    Provisional registration No.                                                                                                                                 APPLICATION No.
                       95404                                                                          Group A                                                         1254595
                                                                            MBBS, BSc (N) & AHS Degree Courses


SECTION I
1. Name of the Candidate (as in School records)

 L A T H A .                                   K S
2. Father's Name                                                                                               3. Mother's Name
SUNDARARAMAN.KR                                                                                                SABITHA.KS
4. Addresss for Communication (Do not enter your Name here)


    10/24 SOUTH MATHAPPA STREET,
    KUMBAKONAM
    KUMBAKONAM
    TAMILNADU


                                                                                                      6 1 2 0 0 1

PHONE : (STD Code - Number)



MOBILE :                                     9 4 4 3 0 9 2 1 0 5
email :                                      leaderskull@sify.com
    5.Sex (M/F)                        6.Date of birth (DD MM YYYY)                                  7.Religion*

          F                   2 9 0 4 1 9 9 5                                                        0 2
    8.Community*                     9.Nationality*               10.State of Domicile*           11. Marital Status*

      0 4                                0 1                           2 9                           0 1
    12. Mother Tongue*               13. Father's Occupation*                14. Qualifying Examination*

      1 5                                                                            0 2
SECTION II
15. Course(s) applied for IN ORDER PREFERENCE
(# Use Course Code from the Bulletin only)

 Course                           Course           Category        If applying as   Sponsorship          Registration
                                 Code(#)         applying under    sponsored,        Code(#)                Fee
                                                                   Indicate
1 Preference               0 0 1                  0 1              Code of
                                                                   Church/                            5 0 0
                                                                   bodies.                                                        18.Payment Details:
2 Preference                                                       (Refer                                                          (Rs. 500 per Course - Group A + Rs. 800 for application)
                                                                   Annexure 1
                                                                   of the
3 Preference                                                       Bulletin                                                                     Rs.1300/-
4 Preference

5 Preference

6 Preference

7 Preference


16. CENTRE FOR ENTRANCE TEST*                                                   17. Applicable only for candidate with minimum
                                                                                2 years experience in the same**. Please select
                                                                                examination paper type*
    1st       1 1              2nd     1 6                                                                                        0 1
  THE COMPLETED FORM WITH ALL ENCLOSURES MUST REACH THE REGISTRAR, CMC, VELLORE 632002 BY 16th APRIL 2012
LATHA.KS
            LATHA.KS

1254595
            1254595
Rs.1300/-
            Rs.1300/-
                              OFFICE OF THE REGISTRAR
                             CHRISTIAN MEDICAL COLLEGE
                                  VELLORE – 632 002
 Dear Mr / Ms. LATHA.KS


                   Your application number                           Your provisional Reg. No. is



                             1254595                                              95404


Use the application number as ID and registration number as password to download your hall ticket after
1st May 2012 from our website http://home.cmcvellore.ac.in/admissions/admin.htm

Please note that your registration is provisional and will be authenticated only after the printed application
form with relevant enclosures are received at our office

DO NOT POST THIS PAGE
KEEP THIS FOR YOUR REFERENCE
                                                                                                      REGISTRAR

				
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