VYDEHI INSTITUTE OF MEDICAL SCIENCES
|Application Form for Selection to Post Graduate Courses In MD/ MS /M.Sc / Diploma Courses Under
Management Seats (N.R.I/I.P) for the Academic Year 20..…. – 20….
A. GUIDELINES TO FILL THE ONLINE APPLICATION FORM
1. Name of Candidate: Fill the name in BLOCK LETTERS, as per 10th/MBBS degree certificate
2. Father’s Name: Father’s Name should correspond to the form and spelling in the 10th standard
3. Spouse’s /Husband’s Name: If married Spouse’s /Husband’s name in full should be filled.
4. Full Postal Address: Enter Full Postal Address with pincode for future correspondences
5. City/State Enter Name of the City & State where residing
6. Pincode: Enter pincode
7. Email ID: Enter Valid Email ID
8. Phone: Enter phone Number with STD code
9. Mobile: Enter Mobile Number
10. Gender: Select form the drop down list Female /Male
11. Date of Birth: The Date of Birth should correspond to the entry in the 10th standard Marks Card.
Ex: if the Date of Birth is 15th January 1965 it should be filled in the format 15/01/1965 only
12. Nationality: Select from the drop down list Indian / other
13. Name of College where MBBS passed: Select college in which you have studied MBBS from the
drop down list .If the college is not listed, select ‘Others’ from the drop down list and then enter the
college name in the field provided.
14. Month / Year of passing : Month / Year of passing from the drop down list
15. Is the MBBS course and college Recognized by Medical council of India Select Yes/No from
drop down List
16. Name of University: Select University in which you have studied MBBS from the drop down list. If
the university is not listed, select ‘Others’ from the drop down list and then enter the university name in the field provided.
17. Type of University : Select from the drop down list Indian / Foreign
18. Permanent / Provisional Medical Registration Number: Enter Permanent /Provisional
Registration Number, if you have already completed the course (Not applicable to candidates who
are still undergoing internship training)
19. Name of State /Central Council Where registered: Enter Name of the State/Central Council
20. Date of completion of Internship: Enter the date of completion of compulsory rotatory internship. If you have not yet completed the compulsory rotatory internship as on the date of filling the application, mention the date on which you are likely to complete the internship supported by a certificate issued by the Principal/Dean of your college to the effect.
21. Please enter the Marks/ Grade Scored in Qualifying: Accordingly enter Marks or Grade awarded
to you in each year.
22. Category: Select from the drop down list the category you belong to
The candidates claiming reservation under SC, ST, Category –I, IIA, IIB, IIIA and IIIB should furnish
latest Income and Caste certificates issued by the Tahasildar in the forms valid as on the last date
for submission of application. If the certificates are not furnished along with the print out of filled
23. Religion: Enter Religion you belong to
24. Caste:Enter Caste you belong to
25. Mother’s Tongue : Enter Mother Tongue / Language
26. Order of Preference : Select subject for admission to Post Graduate course
27. DD Amount: Enter fee payable as given in the brochure
28. DD Number: Enter 6 digits DD Number
29. DD Date: Enter DD Amount in dd/mm/yyyy format only
30. DD Bank Drawn: Enter DD drawn bank
31. Enter Remarks if any
After filling the online application form press Submit button, if you are sure that all the data entered by you is correct. An Application Number will get generated. Please record it for your future usage. Take the printout of the filled-in application and paste the recent passport size photograph in the space provided. The print out of the filled-in application duly signed by the candidate to be sent to college along with the required documents.
B. HOW TO SUBMIT:
I) IN PERSON:
Printout of Application form filled online, along with attested copies of all required certificates may be submitted for registration, in person, The Director Vydehi Institute of Medical Sciences and Research Centre, #82, EPIP Area, Whitefield, Bangalore-560 066”
II) BY POST:
Print out of application filled online, along with attested copies of all required certificates may be sent by post for registration to “The Director Vydehi Institute of Medical Sciences and Research Centre, #82, EPIP Area, Whitefield, Bangalore-560 066” Candidates should super scribe on the cover as “Application for PG Admission”.
C. CERTIFICATES TO BE ENCLOSED:
The attested copies of the following certificates are to be attached along with the application form. The Checklist given in Annexure – I should be used to tick the certificates attached and the checklist be sent along with the application.
D. CONTACT DETAILS
Mrs. D. A Kalpaja
Vydehi Institute of Medical Sciences and Research Centre
#82, EPIP Area,
Whitefield, Bangalore-560 066