BUMS COURSE

Application Page 1 of 4
Reg. Fee: For ST/SC Rs.600/-
Others 800/-
Dr. NTR UNIVERSITY OF HEALTH SCIENCES: ANDHRA PRADESH: VIJAYAWADA-8
APPLICATION FOR TEST CUM ADMISSION INTO BUMS COURSE
FOR THE ACADEMIC YEAR 2014-15
Registration No. _____________
NOTE; Dont Submit filled in applications to the Registrar, Dr. NTR University
of Health Sciences, Vijayawada- 8. If any application received by the University
of Health Sciences, shall not considered under any circumstances.
1. Name of the Candidate (In Capital Letters as in Intermediate Certificate):
___________________________________________________________________
2. Name of the Father/Gaurdians Name:
3. Name of the Mother :
_________________________________________________________________________________
4. Address for Communication
_________________________________________________________________________
_________________________________________________________________________
_____________________________________ PIN CODE: __________________________
5.Sex: Nationality: _________________________
6. Mobile No: _______________________________________________
DATE MONTH YEAR
7. Date of Birth:
8. Reservation claimed:
9. Local Area:
10. a) Passed Intermediate or its
Equivalent Examination with Bi.P.C :
Last Date for submission of filled in application form to the
Principal, Govt, Nizamia Tibbi College, Charminar, Hyderabad on or
before 08.08.2014 by 05.00 PM.
Male Female
OC
BC
SC ST PH
A B C D E
AU OU SVU NL
YES NO
Affix the Latest
Photo graph
duly attested by
the Gazetted
Officer/Principal
of the last
studied college
BUMS COURSE
Application Page 2 of 4
b) Particulars of Marks, in Qualifying Examination in science subjects only (Inter OR
Equivalent Examination):
Science Subjects of Qualifying
Examination
Maximum Marks Marks Obtained
TOTAL MARKS:
c) % of Science Marks (upto two decimal places) :
(Physics, Chemistry & Biology)
Note: Intermediate 10+2 or equivalent examination with fifty
percent aggregate marks in the subjects of Physics,
Chemistry and Biology are only eligible
d) % of total Marks (upto two decimal places):
e) Passed 10
th
Standard With Urdu or Arabic:
or Persian language as a subject
f) If no for (e) above, have you cleared the test of
Urdu in the entrance examination conducted by the
University or Board or Registered Society authorized
by the Government to conduct such examination(Enclose Certificate)
11. Particulars of Study:
SI.
No.
Class Year Name of the School District
1 VI CLASS
2 VII CLASS
3 VIII CLASS
4 IX CLASS
5 X CLASS
6 INTERMEDIATE. Jr.
7 INTERMEDIATE. Sr.
YES NO
YES NO
BUMS COURSE
Application Page 3 of 4
12. Registration fee:- (Details of Demand Draft)
(1) Amount Rs.___________ (2) D.D Number _________________ (3) Date ________________
(4) Name of the Bank ____________________________ (5) Place _________________
DECLARATION
I hereby solemnly and sincerely affirm that the statement made and information furnished by me
in the application form and also in all the enclosures there to submitted by me are true and correct. I
have not kept any information secret. Should it however be found that any information furnished
therein is fraudulent, incorrect or untrue in material particulars, I realize my selection or admission to
the course is liable to be cancelled and I am liable to criminal prosecution. Further I also agree to
forego my seat in the college unconditionally.
I am willing to study B U M S Course and to appear for examinations in URDU only and I will not
claim any other relaxation of study or Examination with regard to Medium of Instruction.
I shall abide by the decision of the Selection Committee which shall be final and binding on me.
,
SIGNATURE OF THE APPLICANT
I have fully read the information furnished by my son/daughter/ward and affirm that it is true
and if it is proved that the information was fraudulent, I am liable to criminal prosecution.
SIGNATURE OF FATHER/GAURDIAN
(if father is not alive)
______________________________________________________________________________
DOCUMENTS TO BE SUBMITTED ALONG WITH THE APPLICATION
1) Certified copy of the SSC or any equivalent examination showing date of birth and other particulars of the candidate.
2) Certified copy of Memorandum of Marks of the qualifying examination making eligible for admission i.e. Intermediate or
Equivalent Examination.
3) Certified copy of Transfer Certificate
4) Candidates who have studied in the state of Andhra Pradesh.
(a) If the candidate has studied in any educational institution, study / bonafide certificate from VI to Intermediate (Govt. /
ZPH/ Private School or College) shall be submitted.
(b) A candidate who has studied in 2 or more institutions in various places in Andhra Pradesh, study / bonafide
certificate from VI to Intermediate (Govt. / ZPH / Private School or College) in those places shall be submitted.
(c) A candidate who has not studied a class in any school / institution, a residence certificate for that period only shall
be submitted.
(d) Candidates who have not studied in any school / college in the state of A.P., but resided in Andhra Pradesh with
private study in Andhra Pradesh seven years residence certificate mentioning the period of residence preceding the
qualifying examination (6
th
to Inter) by the candidate claiming eligibility as a local by virtue of residence shall be
submitted.
5) Candidates who have studied in the institutions outside the state of Andhra Pradesh have to submit 10 years residence
certificate of the either of the parents issued by MRO to claim seats under unreserved category.
6) Attested copy of Certificate of social status in case of one who belongs to Scheduled Caste or Scheduled Tribes or
Backward Classes issued by an Officer prescribed.
7) Candidate claiming eligibility of reservation under PH quota should furnish the required certificate in support their claim.
8) Passport size photo of the candidate attested by a Gazetted Officer.
Note: All the original certificates noted above shall be produced at the time of counseling / selection.
UNIVERSITY (OR) PRINCIPAL SHALL NOT RESPONSIBLE FOR ANY
POSTAL DELAY
BUMS COURSE
Application Page 4 of 4
CANDIDATE COPY
Dr. NTR UNIVERSITY OF HEALTH SCIENCES: A.P: VIJAYAWADA 520 008.
HALL TICKET FOR B.U.M.S ENTRANCE EXAMINATION 2014-15
HALL TICKET NO:
1. Name of the Candidate :
2. Name of Father/Guardian :
3. Sex :
4. Social Status :
5. Identification Marks :
1. __________________________________________________
2. __________________________________________________
6. Date of issue of Hall Ticket: : 21.08.2014 & 22.08.2014
Signature of the Candidate Signature of the Principal,
Govt. Nizamia Tibbi College, Hyderabad
...
OFFICE COPY
Dr. NTR UNIVERSITY OF HEALTH SCIENCES: A.P: VIJAYAWADA 520 008.
HALL TICKET FOR B.U.M.S ENTRANCE EXAMINATION 2013-14
HALL TICKET NO:
1. Name of the Candidate :
2. Name of Father/Guardian :
3. Sex :
4. Social Status :
5. Identification Marks :
1. __________________________________________________
2. __________________________________________________
6. Date of issue of Hall Ticket: : 21.08.2014 & 22.08.2014
Signature of the Candidate Signature of the Principal,
Govt. Nizamia Tibbi College, Hyderabad
Photograph
should be
attested by the
Gazetted Officer
Date of Entrance Test: 24.08.2014 (SUNDAY) from 10-00 A.M to 01.00 P.M
Test Center: Osmania Medical College, Koti, Hyderabad.
Photograph
should be
attested by the
Gazetted Officer
Date of Entrance Test: 24.08.2014 (SUNDAY) from 10-00 A.M to 01.00 P.M
Test Center: Osmania Medical College, Koti, Hyderabad.