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BASIC INFORMATION
Please Fill up the following information in details to take part in e- Registration
(I) Select a Course
:
(II) Name of the Aplicant (Dr):
:
(III) Father's Name
:
(IV) Name of the Husband (For married female applicants)
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(V) Valid E-mail ID (All the communication will be made in this address only, So give a valid e-mail)
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(VI) Landline Telephone No
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(STD Code)
(Phone No)
(VII) Mobile No
:
(Don't put zero before Mob No)
(VIII) Date of Birth (As per Matriculation Certificate)
:
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(IX) Sex
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(X) Reserved Category
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(XI) Domicile / Resident of State
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(XII) AIPGMEE INFORMATION DETAILS
Candidates are advised to provide their accurate information (AIPGMEE Testing ID and Score) in below mentioned Text Boxes, failing which, their candidature will not be considered. No descripancies in this regard will be entertained and the application will be outrightly rejected.
(a) AIPGMEE Testing ID
:
(b) AIPGMEE Score (Out of 1200)
:
(Maximum 4 digit after Decimal Point)
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(XIII) MBBS PARTICULARS
MCI Registration No.
Institute from which Passed
Year of Passing
(XIV) JOB PARTICULARS (Only for those, who are in State Govt. Jobs as on the date of application)
Present Place of Posting
District (CDMO Office)
(XV) ADDRESS FOR CORRESPONDENCE
Permanent Address
Present Address
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At / Plot No
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PO / Taluk / Street
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Via / Ward No
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District
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Pin
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State
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At / Plot No
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PO / Taluk / Street
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Via / Ward No
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District
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Pin
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State
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Technical Help Line-0674-2384894, M-9776640400
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Abinash BehuraPosted Feb 2, 2016, 5:35 AM
Chandu KumawatPosted Feb 2, 2016, 5:21 AM
Abinash BehuraPosted Feb 2, 2016, 5:03 AM
Chandu KumawatPosted Feb 2, 2016, 4:38 AM
Chandu KumawatPosted Feb 2, 2016, 4:38 AM