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    Application Form RM6159

    Uploaded by

    kamado.nezuko28126

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    © All Rights Reserved
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    Application Form RM6159

    Uploaded by

    kamado.nezuko28126
    1 views3 pages

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    1 views3 pages

    Application Form RM6159

    Uploaded by

    kamado.nezuko28126

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 3

    APPLICATION ID : RM6159 VALID PRINT

    OFFICE OF THE CHAIRMAN,


    NEET UG Medical & Dental Admission/Counseling Board-2023 AND
    RUHS College of Dental Sciences (Govt. Dental College), Jaipur

    NEET UG (MEDICAL / DENTAL) COUNSELING 2023 (MBBS, BDS) (State of Rajasthan)


    APPLICATION FORM
    Course applied for : MBBS Category : GENERAL
    Opted for NRI seats : NO
    Application ID : RM6159 NEET 2023 roll no. : -3901060066 Affix photo (as was
    NEET 2023 score : 578 uploaded at the time
    of filling on-line
    Payment Type : APP. Reciept No. : 112950718942 Amount Rs. : 2000 application form)
    Payment Type : CHOICE Reciept No. : 112956036660 Amount Rs. : 10000

    Name : AVNEET SINGH


    Date of birth : 25-05-2003
    Gender : MALE
    Father's Name : MANJEET SINGH
    Mother's Name : MANPREET KAUR
    Present address : 10 B CHISHTY VILLA SRINAGAR ROAD ALWAR GATE, AJMER - 305001, AJMER,
    RAJASTHAN
    Permanent address : 10 B CHISHTY VILLA SRINAGAR ROAD ALWAR GATE, AJMER - 305001, AJMER,
    RAJASTHAN
    Residence phone : - Cell no. : 8875795872
    email ID : [email protected]
    Birth State : RAJASTHAN
    Domicile State : RAJASTHAN
    Nationality : INDIAN
    Category : GENERAL
    PwD : NO
    WDP / WPP : NOT APPLICABLE
    EWS : YES
    Family annual income is less than INR 2.5 lacs : NO
    Aadhaar/Enrollment No. : 6542****3851
    OTHER ELIGIBILITY CRITERIA

    I. Natural father/Mother of the candidate has continuously resided in Rajasthan for period of last 10 years and the
    candidate has studied for at least 5 years during this period in a recognized educational institution in Rajasthan

    Educational details
    Secondary (10th ) or an equivalent examination
    Name of board : CENTRAL BOARD OF SECONDARY EDUCATION
    Year of passing : 2019 Percentage of total marks : 81.08%
    10 + 2 or an equivalent examination
    Name of board : CENTRAL BOARD OF SECONDARY EDUCATION
    Result status : PASSED Year of passing : 2021 No. of attempts : 1
    Percentage of marks in Physics : 73.00%, Chemistry : 76.00%, Biology : 76.00%, English : 81.00%
    Total percentage of Physics, Chemistry, Biology : 78.00 %

    Page 1 of 3 Contd..
    APPLICATION ID : RM6159

    Declaration :
    I do hereby declare that all the information given by me in support of my application for registration is true, complete and
    correct to the best of my knowledge, is binding on me and nothing has been hidden by me. I shall not claim any change or
    alteration. If any of them is found to be incorrect or false, my candidature will be liable to be rejected and I shall be liable
    to any penal action and / or punishment as may be deemed fit by the UG admission board.

    I have gone through all the rules, information booklet, instructions for filling on-line registration form college information
    sheet, notification(s), fee structure etc. and I promise to abide by them.

    I fulfill the prescribed eligibility criteria relating to educational qualification etc. for the course(s) I am applying for.

    I hereby agree, if admitted, to abide by the rules and regulations in force at the college or those that may hereafter be made
    for administration of the college and I undertake that so long as I am a student of the college, I will do nothing either inside
    or outside the college that will interfere with its orderly working and discipline.

    Applicant's signature (in box)

    Left thumb Right thumb

    Place : AVNEET SINGH

    Date : RM6159

    Page 2 of 3 Contd..
    APPLICATION ID : RM6159

    Enclosures (as applicable):


    1.NEET 2023 Score Card
    2.Allotment Letter
    3.Mark sheet of 10+2 (senior school certificate examination) or its equivalent
    4.Date of Birth Certificate: 10th class mark sheet / certificate or any other equivalent certificate showing the date of birth
    5.Mark sheet of secondary examination (10th class)
    6.Mark sheets of Class 11 bearing Biology as one of the subjects (if passed in more than one attempt, all mark sheets are
    required)
    7.Mark sheets of Class 12 bearing Biology as one of the subjects (if passed in more than one attempt, all mark sheets are
    required)
    8.Certificate/ Document providing your eligibility as selected by you at the time of filling on-line application form- (I to XI) -
    as given under serial 3 under other eligibility criteria in the information booklet
    9.Copy of photo ID (driving licence / PAN card / Voter ID / Govt. or PSU card / School ID card / 12th class examination
    admit card / Aadhaar card)
    10.Valid Caste certificate, sub-category certificate, if applicable
    11.Domicile certificate, if applicable
    12.4 Passport size photo same as affixed on application form
    13.Valid PwD certificate issued by 16 centers designated by MCC for NEET 2023, if applicable
    14.Valid WDP / WPP certificates, if applicable
    15.Valid EWS certificate, if applicable
    16.Bond / Bank Guarantee as per the applicable Proforma
    17.Proof regarding family annual income less than INR 2.5 lacs, if applicable

    Additional documents for candidates applying for NRI seats:


    18.If the Sponsor NRI/OCI/PIO is currently residing in India, a proof in the form of certificate issued by the Indian
    embassy in the concerned Country/Ministry of external affairs, Government of India for this purpose is essential
    alongwith undertaking in the prescribed Proforma-3 on non-judicial stamp paper of Rs. 50/- executed by Sponsor NRI
    /OCI/PIO and duly notarized.
    or
    If the Sponsor NRI/OCI/PIO is residing outside India, a duly notarized undertaking in the prescribed Proforma-4 executed
    by the sponsor and notarized by the Notary Public of the foreign country where the sponsor resides being submitted by
    the sponsor, it be treated as sufficient as to the factum of the residence of the sponsor. NRI undertaking must have been
    issued on or after date of NEET 2023 examination i.e. 07.05.2023.

    19.Father/Mother/Guardian shall also submit an undertaking regarding relationship between Sponsor and candidate in
    Proforma-5 alongwith the address of parents and local (Indian) guardian.
    20.Address proof of parents and local (Indian) guardian.

    Name : AVNEET SINGH


    Registration ID : RM6159
    Date and time of locking : 26-07-2023 23:55
    Date and time of printing : 12-09-2023 17:58

    NOTE:
    Keep the completed application form for submission when required. You are not required to send to
    UG admission board the print copy of your application form filled on-line. You will be required to
    submit this printcopy of the application form (duly completed in all respects) at the time of reporting
    before the admission board / allotted college.

    Page 3 of 3

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