APPLICATION FORM FOR COMEDK PGET-2012
For those intending to apply to member institutions seeking admissions to
I Year Postgraduate Programme for Medical/Dental during 2012-2013

Application Number:       
Name of the Applicant :
Date of Birth:
 
Course applying for:
Gender:
Nationality:
Belongs to:
By Birth / Domicile:
Category:
Parents/Applicant Annual Income:
Address:

City:  
State:
Pincode:
DD No.:      DD Amount:     DD Date: 
Drawee Bank:
Phone No.: Mobile No.:
Email ID:
Qualifying Exam :    
Type of University:               Month / Year of Passing:  
University last studied:
Completed / would be completing Internship by 30/04/2012:
Month / Year of completing Internship:
No. of Attempts in COMEDK PGET:    Result:
Marks Obtained in the Qualifying Examination (M.B.B.S. / B.D.S.)
Year Maximum Marks Marks Obtained Grade Obtained No. of Attempts
I Year
II Year
III Year
IV Year
TOTAL  
Declaration : I hereby declare that the particulars given in this form are true to the best of my knowledge & belief.
sign
      Date:                                                                 Place:                                                   


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