MRIMS PG Admission Form

NEET DETAILS

Hall Ticket Number

Score

Rank

Result

Name as per MBBS Degree Certificate

Date of Birth(DD/MM/YY)

Gender

Nationality & Religion

Caste/Category

Domicile State

Do you belong to minority category?

Aadhar No.

Student Pan No.

Father's Name

Father Mobile No

Mother's Name

Mother Mobile No

Guardian’s Name

Guardian Email Id.

Address(Permanent)

City

Pincode

Local Guardian Name(If Any)

Guardian Mobile No

Admission Category

Age

Place of Birth

Mother Tongue

Special Category

Domicile Country

Blood Group

Student Mobile No

Student Passport No.

Father Occupation

Father Email ID

Mother Occupation

Mother Email ID

Guardian Mobile No.

Total Annual Parental Income

Corresponding Address

City

Pincode

Guardian Email

Student Email

ACADEMIC DETAILS

MBBS Details

College Name

University Name

From

MCI/NMC Registration Certificate(for FMGs only)

Place/Country

Internship Details

From

Name & Place of the Hospital

Details of Registration: Name of State Medical Council

Permanent Registration Number:

Temporary / Permanent Registration Number:

Date & Place of Registration:

Details of Registration with Telangana Medical Council

Date & Place of Registration:

Marks obtained in MBBS (Total 4 ½ years marks)

Year

I MBBS

II MBBS

Final MBBS Part I

Final MBBS Part II

Total

Marks Obtained

Max. Marks

Percentage

MISCELLANEOUS INFORMATION

Extra Curricular / Sports Activities

Games / Sports and Level of Participation (School/College State/National)

Details of Extra Curricular Activities (if any)

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Kindly check each field of the application before submitting.Once submitted form will not be edited.

Declaration by the Candidate:

I declare that the information given above is true to the best of my knowledge. My admission is liable to be cancelled if any of the above information is false. I also undertake to abide by the rules and regulations as laid down by the management of Malla Reddy Institute of Medical Sciences a constituent unit of Malla Reddy Vishwavidyapeeth (Deemed to be University).

APPLICATION FOR ADMISSION INTO PG (MD/MS) COURSE ACADEMIC YEAR 2024-2025