FPMT-2018 APPLICATION FORM FOR ADMISSION TO MBBS/MD COURSE IN FOREIGN TOP MEDICAL UNIVERSITIES To be filled in CAPITAL Handwriting only ADDRESS: NAME: FATHER: OCCUPATION: MOTHER: OCCUPATION: Date of Birth: SEX : M F PASTE RECENT PHOTOGRAPH STATE : NATIONALITY : EMAIL: GEN/SC/ST/OBC : FPMT 2018 PAPER ENGLISH LANGUAGE : MOBILE NO. : WHATSAPP NO. : 12TH PASSING YEAR/ APPEARING 11TH PASSING APPEARING YEAR ENGLISH : PHYSICS : CHEMISTRY : IF 12TH PASS THEN MARKS OBTAINED BIOLOGY : HINDI(OR OTHER) : Total % : IN NEET 2018 SCORE : CHOICE OF UNIVERSITY (IF ANY): : TOTAL FEES AFFORDABILITY FOR FULL MBBS COURSE 3 CHOICE OF COUNTRY (ANNEXURE 3 BELOW THIS FORM) 10-15 LAKHS 15- 20LAKHS 20-25LAKHS 25-40LAKHS I here by declare that I have been submit the mark sheet & certificate of 10th & 12th with this form. I have read and understood all the Rules & Regulations governing FPMT-2018. I here by declare that the above information is true and complete to the best to my knowledge. I am aware that if any information found to be incomplete my application form will be rejected/admission will be cancelled. Place : Date : SIGNATURE OF CANDIDATE
FPMT-2018 APPLICATION FORM FOR ADMISSION TO MBBS/MD COURSE IN FOREIGN TOP MEDICAL UNIVERSITIES To be filled in CAPITAL Handwriting only NAME: FATHER: OCCUPATION: MOTHER: OCCUPATION: Date of Birth: SEX : M F ADDRESS: PASTE RECENT PHOTOGRAPH STATE : NATIONALITY : EMAIL: GEN/SC/ST/OBC : FPMT 2018 PAPER LANGUAGE : MOBILE NO. : ENGLISH WHATSAPP NO. : 11TH PASSING YEAR 12TH PASSING YEAR/ APPEARING APPEARING IF 12TH PASS THEN MARKS OBTAINED IN ENGLISH : PHYSICS : CHEMISTRY : BIOLOGY : HINDI(OR OTHER) : Total % : NEET 2018 SCORE : CHOICE OF UNIVERSITY (IF ANY): 3 CHOICE OF COUNTRY : (ANNEXURE 3 BELOW THIS FORM) TOTAL FEES AFFORDABILITY FOR FULL MBBS COURSE 10-15 LAKHS 15- 20LAKHS 20-25LAKHS 25-40LAKHS I here by declare that I have been submit the mark sheet & certificate of 10th & 12th with this form. I have read and understood all the Rules & Regulations governing FPMT-2018. I here by declare that the above information is true and complete to the best to my knowledge. I am aware that if any information found to be incomplete my application form will be rejected/admission will be cancelled. Place : Date : SIGNATURE OF CANDIDATE
APPLICATION%20FORM%20FPMT-2018.docx