Name of the Year of Passing Total Max Total Marks obtained Institute & Examination Marks (I to Obtained (I to Final in percentage University Final year) year) % MDS _______________________________ (specialty) Name of the Year of Passing Total Max Total Marks Marks obtained Institute & Examination Marks (I to Obtained (I to Final in percentage % University Final year) year) or Division 9. Details of work experience after MDS: Place of work Name of Designation Pay or Period of employment – Hospital/Institute/Clinic with address Gross Salary From To 10. * Documents must be self i) Age Proof attested ( indicate mark ii) Caste Certificate ( SC/ST/OBC ) against the certificates iii) BDS Degree attached) iv) Internship Completion Certificate v) Attempt Certificate vi) MDS Degree/ Provisional Degree vii) State Dental Council Registration viii) Experience Certificate ix) 2 Passport size photograph (one to be affixed on form and one separately) 11. Bank No. ________________ Dated: __________________Amount: ____________ Name of Issuing Bank with Address_____________________________________________________
Name of the Institute & University Year of Passing Examination Total Max Marks (I to Final year) Total Marks Obtained (I to Final year) obtained in percentage % MDS _______________________________ (specialty) Name of the Institute & University Year of Passing Examination Total Max Marks (I to Final year) Total Marks Obtained (I to Final year) Marks obtained in percentage % or Division 9. Details of work experience after MDS: Place of work – Name of Hospital/Institute/Clinic with address Designation Pay or Gross Salary Period of employment From To 10. * Documents must be self attested ( indicate mark against the certificates attached) i) Age Proof ii) Caste Certificate ( SC/ST/OBC ) iii) BDS Degree iv) Internship Completion Certificate v) Attempt Certificate vi) MDS Degree/ Provisional Degree vii) State Dental Council Registration viii) Experience Certificate ix) 2 Passport size photograph (one to be affixed on form and one separately) 11. Bank No. ________________ Dated: __________________Amount: ____________ Name of Issuing Bank with Address_____________________________________________________