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MBBS Adm
e-form
Submission
Malda Medical College, Malda
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* Indicates required question
Email
*
Your email
Candidate's
Mobile Number
*
Your answer
Applicant's Name
*
Type in
Proper Case
only
Your answer
Gender
*
Choose
Male
Female
Date of Birth
*
Type in
DD-MM-YYYY
Format Only
MM
/
DD
/
YYYY
Type of Selection Quota
*
Choose
AIQ
WB State Quota
NEET UG
AIQ
Rank
*
Your answer
West Bengal State Rank
AIQ Candidates need not to fill this option
Your answer
Passed 10+2 in the Year
*
Choose
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
Name of the School / College at 10+2 Level
*
Type in
Proper Case
Only
Your answer
Name of the Board/ Council/ University
*
Type in
Proper Case
Only
Your answer
FULL MARKS OF EXAMINATION OF
PHYSICS
*
Your answer
PERCENTAGE OF MARKS OBTAINED IN
PHYSICS
*
Your answer
FULL MARKS OF EXAMINATION OF
CHEMISTRY
*
Your answer
PERCENTAGE OF MARKS OBTAINED IN
CHEMISTRY
*
Your answer
FULL MARKS OF EXAMINATION OF
BIOLOGY
*
Your answer
PERCENTAGE OF MARKS OBTAINED IN
BIOLOGY
*
Your answer
FULL MARKS OF EXAMINATION OF
ENGLISH
*
Your answer
PERCENTAGE OF MARKS OBTAINED IN
ENGLISH
Your answer
AGGREGATE PERCENTAGE OF MARKS OBTAINED IN
PHYSICS, CHEMISTRY AND BIOLOGY
*
Your answer
AFTER (10+2) HAVE YOU ADMITTED / STUDIED TO ANY OTHER COLLEGE / COUNCIL -
UNDER
WEST BENGAL UNIVERSITY OF HEALTH SCIENCES BEFORE TAKING ADMISSION TO MALDA MEDICAL COLLEGE? IF YES GIVE COLLEGE NAME, COURSE NAME, REGISTRATION NO. - IF NOT PUT
NO
ONLY
*
Your answer
AFTER (10+2) HAVE YOU ADMITTED / STUDIED TO ANY OTHER COLLEGE / COUNCIL
OTHER THAN
WEST BENGAL UNIVERSITY OF HEALTH SCIENCES BEFORE TAKING ADMISSION TO THE MALDA MEDICAL COLLEGE? IF YES GIVE COLLEGE NAME, COURSE NAME, REGISTRATION NUMBER IF NOT PUT
NO
ONLY
*
Your answer
Candidate by Caste
*
Choose
Hindu
Muslim
Christian
Buddhist
Parsi
Jain
Sikh
Other
Caste Category (If Any)
*
Choose
GENERAL
EWS
SC
ST
OBC A
OBC B
PwD
Caste Certificate issued by
-
General Candidate will type as
NA
to this option
*
Your answer
Caste Certificate
Issue
Date
Type as DD MM YYYY Format
MM
/
DD
/
YYYY
Did You Availed Any
Government Scholarship
From Government in 10+2 Level.
If Yes
Give Scholarship Name
*
Your answer
Are you Physically Handicap?
*
Choose
No
Yes
Mention your Blood Group
*
Choose
A +
B +
A -
B -
AB +
AB -
O +
O -
Bombay
Candidates AADHAAR number
*
Your answer
Candidates Epic No Voter ID Number
*
Your answer
Applicant's valid
e-mail
Address
*
Your answer
Applicant's
Present Address
with Postal PIN Code
*
Your answer
Applicant's
Permanent Address
including Land Mark
*
Your answer
Post Office
*
Your answer
Postal
PIN
Code
*
Your answer
Police Station
*
Your answer
District
*
Your answer
State
*
Your answer
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