Application Form for 1st Year Postgraduation Program for Medical / Dental 2014-2015
Read Instructions carefully before filling the Online Application Form
Mandatory Documents ( Following documents have to be enclosed along with the Online Application Form)
1. Demand Draft 2. SSLC/10th Marks Card 3. All Marks Cards ( MBBS/BDS)
4. Attempt Certificate 5. Internship Certificate 6. Degree Certificate
7. Registration Certificate 8. Category/Minority Certificate Read more….
The completed Application Form with all the enclosures mentioned above has to reach COMEDK office by speed post or courier on or before Friday the 3rd January 2014 (before 5:00 PM) to the following address.

The Executive Secretary - COMEDK
# 132, Second Floor, 17th Cross,
11th Main, Malleswaram,
Bangalore-560055, Karnataka.
Phone: 080-41132810

Name of the Applicant *
Do not add any prefix(Eg. Mr. Ms. Dr.)

Re-Enter Name *
Do not add any prefix(Eg. Mr. Ms. Dr.)


Date of Birth *
Re-Enter Date of Birth *
Course applying for *
Gender *
Nationality *
Parent/Applicant Annual Income (in Rs) *
Belongs To *
By Birth / Domicile
Category Details Re-Enter Category Details
Category * Category *
If OBC If OBC
----------- If you belong to any of the Minority Status,select Yes or No. -----------
Minority Status
Minority Status
Linguistic Minority
Linguistic Minority
Religious Minority Religious Minority
Permanent Address Details Correspondence Address Details
Line 1 * Line 1 *
Line 2 Line 2
Line 3 Line 3
City * City *
if Others if Others
State * State *
Pincode *
Pincode *
Tick If Permanent & Correspondence Address is Same
Phone Number
(With STD Code Phone number e.g. 08012345678)
Mobile Number
Atleast one of the contact details is Mandatory
Email Id *
Payment Details Demand Draft (DD) Only
DD Amount Rs. 2250/- DD No. *
Drawee Bank * DD Date *
DD drawn only from Nationalized bank in favour of “COMEDK”, Payable at “Bangalore” and Seal and signature of Bank Authority on DD is mandatory.
Academic Details
Qualifying Exam * Type of University *
University *
If Others Month/Year of Passing *
Completed / would be completing Internship by 30/04/2014 * If Completing, Mention the Month / Year
No. of Attempts in COMEDK PGET Result
Marks Obtained in the Qualifying Examination
Sl. No. Year Maximum Marks Marks Obtained Grade No of Attempts
1. First Year *
2. Second Year *
3. Third Year *
4. Fourth Year *
Grand Total