PDF Format - Bapuji Dental College

Bapuji Educational Association ®
BAPUJI DENTAL COLLEGE & HOSPITAL
(Recognized by the Dental Council of India, New Delhi)
DAVANGERE-577 004 (Karnataka)
ACCREDITED BY NAAC WITH ‘A’ GRADE
Website:www.bapujidental.edu
E-mail: principal@bapujidental.edu , bapujidental@gmail.com
APPLICATION FOR ADMISSION TO B.D.S. COURSE FOR THE ACADEMIC YEAR 2016-17
Estd. 1979.
1)
2)
3)
Name of the Applicant
(In Block letters)
(As per Tenth marks card)
(a) Name of the Father or Guardian, if the father is
not alive
(b) Name of the Mother
Address for Correspondence:
(in block letters)
Mobile No:
Phone No. with STD Code:
4)
Permanent Address
(in Block Letters)
Mobile No:
Phone No. with STD Code
5)
(a) Nationality
(b) Caste & Religion
(c) Whether you belong to
Scheduled Caste or Tribe?
Specify Caste
(d) Sex
Male / Female
(e) Date of Birth & Place of Birth
6)
Details of qualifying Examinations passed:
Examination
Name of University or Board
Year of
Passing
Optional
Subjects
Marks in Science Subjects
(Excluding Mathematics)
8) Institutions at which the applicant studied during the last FIVE years
1
Institution Name & Address
Place & State
Year
2011-12
Class
VIII
2
2012-13
IX
3
2013-14
X
4
2014-15
XI
5
2015-16
XII
DECLARATION BY THE CANDIDATE
I hereby declare that the information given above is true and correct to the best of my knowledge and I further declare
that I shall abide by the rules and regulations of the College and the University.
NEETSCORE & %
NEET RANK
:
:
Signature of Parent / Guardian
/
KEA CET SCORE & %:
KEA CET RANK
:
Date:
Cell No:
/180
Signature of the Applicant
Cell No:
INSTRUCTIONS TO APPLICANTS
1.
2.
3.
4.
5.
6.
Candidates must have passed individually in the subjects of Physics, Chemistry, Biology and English and must have obtained a minimum of
not less than 50% marks in Physics, Chemistry & Biology taken together in the qualifying Examination. In respect of Scheduled Castes/
Scheduled Tribes and Category I, the minimum marks prescribed shall be not less than 40% of the total marks in lieu of 50% marks for
general candidates.
This application along with one set Photostat copies of the Marks Cards of X, XII Standard & Transfer Certificate, Migration Certificate,
two passport size photographs (glossy), Admission Ticket, Score & Rank Card of CET / NEET should be sent to The Principal, Bapuji
Dental College and Hospital, Davangere – 577 004. (Karnataka) by Registered Post/ Speed Post
Scheduled Caste/Scheduled Tribe students should produce the Caste and Income Certificate issued by the Tahasildar for current academic
year at the time of Admission.
Students other than pre-university board of Karnataka have to produce Eligibility Certificate at the time of admission. However, they have
to apply before closing date to the Registrar, Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore 560 041 along with
prescribed fees through challan Please see the Rajiv Gandhi University of Health Sciences Website for details. Website: www.rguhs.ac.in
(Ph.No.080-26961928 / 26961929)
All correspondence should be addressed to The Principal, Bapuji Dental College and Hospital, Davangere – 577 004.
Duration of the BDS Course is 5 ( Five) Years including one year compulsory rotatory internship and course should be completed within 9
( Nine ) Years as per university rules. As per the Principle Revised BDS Course Regulations, 2007, amended its Principle
Revised BDS Course Regulations, 2007 and provided inter-alia for that “ Any student who does not clear the BDS Course in
all the subjects within a period of 9 years, including one year Compulsory Rotatory paid Internship from the date of
admission shall be discharged from the course”. The Revised BDS Course (7th Amendment) Regulations, 2015 has been
notified and published in the official gazette on 27/04/2015 and as such come into force since then.
7.
Students who are discontinuing in the middle of the course under any circumstances, they have to pay the total duration of course fees (
TOTAL 4 YEARS ) as per BEA Circular No: BEA/16/ADM/143/09-10 Dt: 07-09-2009.
8. . Under any circumstances students who lodged a complaint in Police Station or received notices from police station, a copy of the same
STUDENT GENERAL INFORMATION:-
1.
2.
3.
4.
5.
6.
7.
8.
Student Name in Block Letter
Cell No:
E-mail :
Mother tongue:
Seat Category
MGT/COMEDK/ KEA GOVT/ NEET
Blood Group
Father’s Name
Cell No:
E-mail :
Mother tongue:
Occupation of Father & Address with
Telephone Nos.& STD Code
Pan Card Number:
Mother’s Name
Cell No:
E-mail :
Mother tongue:
Occupation of Mother & Address with
Telephone Nos. & STD Code
Pan Card Number:
Name & Occupation of the Guardian &
Address with Telephone Nos. & STD Code
9. Parents Annual Income
10. Caste & Religion
Caste Category
Caste & Income Certificate in case of SC, ST &Group
:A.B.C.D.&E Affidavit to be Enclosed.
11. Area
12. State
13. Pass-Port & Visa details
14. Any Emergency whom to contact
Address with Telephone / Cell No:
Rs.
Caste:
Religion
GM/GMR/1G/1R/2AG/2AR/2BG/2BR/ SC/ST
URBAN/ RURAL
No:
Valid upto:
(FOR BDS)
BAPUJI DENTAL COLLEGE & HOSPITAL, DAVANGERE
I hereby agree to produce the following documents at the time of admission.
Original Marks cards/ certificates
10th std Marks cards & certificates
12th std Marks card & certificate
Transfer certificate
Character certificate
Date of Birth certificate
Migration certificate by Board
Physical fitness certificate with marks of identification
Original Rank card KEA CET/NEET
Scheduled Caste/ Scheduled Tribe students should produce Caste & Income
Certificate ( Karnataka Students only)
10. 4 Nos. Passport size and 2 Nos. stamp size photographs of student
11. Passport size photographs of Father, Mother and Guardian (one each).
12. Eligibility Certificate from Rajiv Gandhi University of Health Sciences,
Karnataka, Bangalore ( Other than Karnataka State syllabus students). Website : www.rguhs.ac.in
13. Registration fees, eligibility fees to be paid separately in case of Foreign students
14. Passport & Visa copies in case of Foreign students
15. NOC from Ministry of Health & Family welfare, Dept. of Health, Delhi (In case of Foreign
Nationals)
16. Pan card of the parents ( Photocopy)
17. Submit the affidavits on white paper duly certified and signed by Oath Commissioner or Notary
each in respect of ragging.
18. For Management Students : Compulsory to Submit Rank Card ( NEET Qualified Rank card)
19. For NRI Students – Compulsory to submit NRI Sponsorer letter and Passport photocopy of the
Sponsorer
1.
2.
3.
4.
5.
6.
7.
8.
9.
Signature of the candidate