NGMC

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MBBS Course Admission Application

Personal Details

First Name *

Last Name *

Father's Name *

Sex *

Male

Female

Marital Status *

Single

Married

If Married, state maiden name

Date of Birth Details

Date of Birth (in AD) *

Birth Place

District

State

Country

Religion

Nationality *

Address For Communication

Full Name

Address

PIN code

Telephone No.

Mobile No.

Fax

Email *

Name & Address of the Parents/Guardian

Full Name *

Address

PIN code

Telephone No.

Mobile No. *

Fax

Email

Relationship with Student *

Occupation

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