Application form for Admission in
Course for the session
2020 - 2021

Name
Gender
Date of birth
Father's Name
Father's Occupation
Father's Mobile No.
Mother's Name
Mother's Occupation
Mother's Mobile No.
Father's PAN No.
Mother's PAN No.

Nationality
State Domicile
Category
Minority
Student's Email
Student's Mobile No.
Student's Alternate Mobile No.
Passport number
Aadhar number
Blood Group

Permanent Address
Country
City
District
State
Pin Code
Landline
Correspondence Address
Country
City
District
State
Pin Code
Landline

Guardian Name
Relationship
Guardian's Email
Guardian's Mobile No.
Guardian's Alternate Mobile No.
Guardian's Address
Country
City
District
State
Pin Code
Landline

Details of Last Qualifying Exam (10/10+2/Diploma/Graduation/Post Graduation)
Name of Examination
Board / University
Year of Passing
Name of Institution

Educational Qualification
Name of Examination Year of Passing Subjects School / College Board / University Max. Marks Marks Obtained % / OGPA / GPCA / CGPA
10th
12th
Diploma / Any Other
Graduation
Post Graduation
Details of Marks of Physics, Chemistry, Biology, English in 10+2
Class Subject Max. Marks Marks Obtained % / OGPA / GPCA / CGPA
12th Physics
Chemistry
Biology
English
Details of Entrance Examinaion
Name of Exam. RollNo Merit Max. Marks Marks Obtained Percentile
NEET

Mode of Admission  
Whether Transportation Facility is required  
Whether Hostel Facility is required  

Student's Photo
Student's Signature

Contact Us

Pacific Dental College and Research Center
Bhilon ka Bedla,Pratap Pura, N.H.76, Teh-Girwa Udaipur
Rajasthan-313024

Ph: 0294-3920000 Mob. 91 9649298767

Email: pdcrc2015@gmail.com/a>

Website: www.pmudental.ac.in

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