NITISHWAR AYURVED MEDICAL COLLEGE & HOSPITAL
& P.G RESEARCH INSTITUTE

BAWAN BIGHA, MUZAFFARPUR - 842002

APPLICATION FORM

IMPORTANT: THIS FORM IS FILLED BY THE CANDIDATE IN CAPITAL LETTER ONLY.

COURSE APPLY FOR :
CANDIDATE NAME :
SEX :
CATEGORY :
DATE OF BIRTH :
RELIGION :
NATIONALITY :
FATHER'S NAME :
OCCUPATION :
MOTHER'S NAME :
POSTAL ADDRESS :
PERMANENT ADDRESS :
MOBILE NUMBER :
PHONE NUMBER :
EMAIL ID :
Are you enrolled in or
seeking seeking Admission to
any course in any
College/ University/ Institute
Concurently If yes Give Details.
:
Educational Qualification : MATRIC(10th)
: 10+2(SR.ISC.)
: GRADUATE(B.A.M.S)
: ANY OTHER
AADHAR NUMBER :
DATE :
Candidate Photo(Size 20-50KB) :
Candidate Signature (Size 20-50KB) :