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MARATHA MANDAL’S NATHAJIRAO G. HALGEKAR INSTITUTE OF DENTAL SCIENCES AND RESEARCH CENTRE, BELGAUM
APPLICATION FORM FOR ADMISSION TO THE FIRST YEAR B.D.S COURSE
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NAME OF THE CANDIDATE
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PERMANENT ADDRESS
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PRESENT ADDRESS
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MOBILE NUMBER OF CANDIDATE
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MOBILE NUMBER OF PARENTS
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EMAIL ID
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AADHAR NUMBER
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DATE OF BIRTH
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DD
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YYYY
PLACE OF BIRTH
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BLOOD GROUP
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DISTRICT
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STATE
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RELIGION/CASTE/COMMUNITY
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PAN CARD NUMBER
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TOTAL MARKS OF 12TH/PUC WITH SUBJECT NAMES
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TOTAL MARKS OF PHYSICS, CHEMISTRY,BIOLOGY WITH PERCENTILE
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NEET RANK NUMBER
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NEET PERCENTILE
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PAN CARD NUMBER OF PARENTS
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ANTI-RAGGING UNDERTAKING NUMBER
**
To
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filled Online Undertaking on www.antirahhing.in/www.amanmovement.org
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