MUNIYAL INSTITUTE OF AYURVEDA MEDICAL SCIENCES

A unit of Dr. U. Krishna Muniyal Memorial Trust (R)

 

34-C, Shivally Industrial Area, MANIPAL - 576 104.  E-mail: ayurved@yahoo.com

Ph: 91-0820-2572819 / Tele-Fax: 91- 0820-2575025

Cell: 0-93422 34249

 

Application for Admission

to First Professional Course of the

AYURVEDACHARYA (B.A.M.S.) DEGREE COURSE

(Please Include Recent Passport size photo of the applicant)

 

 

1.	Applicant's Name (in full and block letters)
2.	Father's Name
3.	a) Name of the Guardian
	b) Relationship to the applicant
4.	Present address of Father / Guardian
5.	Permanent address of the Father / Guardian
6.	Village, Taluk, District to which the applicant belongs
7.	Telephone No.
8.	Date of Birth
9.	Sex
10.	Nationality
11.	Religion
12.	Mother tongue
13.	Annual Income of Parent / Guardian
14.	Whether the applicant is vaccinated or pock marked?
15.	The defects. if any discovered at the last Medical Examination. Have they been remedied?
16.	Name of the College last attended
17.	Month and year of passing Pre University / Equivalent Examinations with Reg. Nos.
	Percentages of Marks
	Percentages of Marks  in optional Subjects (II Year PCB)

 

 

True Copy of Certificates to be attached at the time of Registration

 

1.         Pre University / B.Sc. Marks Card

2.         Conduct Certificate

3.         Date of Birth Certificate

4.         Medical Fitness Certificate

5.         University Eligibility Certificate (For outside Karnataka Candidates)

6.         Migration Certificate (For outside Karnataka Candidates)