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Kims University Kaiet-2015.PDF 11111

Pooja Kakade applied for admission to the MBBS program at Krishna Institute of Medical Sciences Deemed University. She is from Washim, Maharashtra and completed her application form on May 12, 2015. She paid an application fee of Rs. 1500 via a demand draft. Pooja declared that all information provided in her application is true and agreed to abide by the rules and regulations of the university if admitted. Her father Babanrao Kakade also signed to acknowledge the financial obligations of admitting Pooja to the university and endorsed her application.

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Patricia Joseph
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98 views2 pages

Kims University Kaiet-2015.PDF 11111

Pooja Kakade applied for admission to the MBBS program at Krishna Institute of Medical Sciences Deemed University. She is from Washim, Maharashtra and completed her application form on May 12, 2015. She paid an application fee of Rs. 1500 via a demand draft. Pooja declared that all information provided in her application is true and agreed to abide by the rules and regulations of the university if admitted. Her father Babanrao Kakade also signed to acknowledge the financial obligations of admitting Pooja to the university and endorsed her application.

Uploaded by

Patricia Joseph
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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5/12/2015 KIMS UNIVERSITY KAIET-2015

KRISHNA INSTITUTE OF MEDICAL


SCIENCES DEEMED UNIVERSITY Application
(Declared U/s of UGC Act, 1956 vide notification No.F.9-15/2001-U.3 of Ministry of Human No.
Resource Development, Govt. of India)
Karad, Dist.Satara (Maharashtra State), Pin: 415110
Phone: (02164) 241555/6/7/8, Fax: (02164) 243272/242170 1411140
WebSite: www.kimsuniversity.in
KAIET - 2015 APPLICATION FORM for
(MBBS & BDS)

Course Preference: MBBS

Candidate's Name : KAKADE POOJA BABANRAO

Father's/Mother Name : BABANRAO SURYABHAN KAKADE

Date of Birth : 23/08/1995

Gender : Female

Address : DATTA NAGAR LAKHALA WASHIM


Paste Your Recent Color
TQ. DIST.WASHIM Photograph as per the
instructions in the
MAHARASHTRA
brochure.
City : WASHIM Pin : 444505

State : MAHARASHTRA

Mobile Number : 9763282177 Tele. No. : 07252-233977

Category : OBC

Choice of Centre : 14-NAGPUR


Signature of the Candidate
Email : santosh456@gmail.com

Demand Draft Details : Bank : BANK OF MAHARASHTRA

D.D. No : 881739 D.D. Amount : Rs. 1500/- D.D. Date : 12/05/2015

De claration

1. I hereby declare that the above information is true and complete to the best of my know ledge. I am aw are that if any
information herein is found to be incorrect or incomplete, my application form w ill be rejected / admission w ill be cancelled.
2. If admitted to this Institution I shall abide by its Rules & Regulations.
3. I have read and understood all the provisions contained in the brochure and hereby agree to abide by these provisions.

Le ft Thum p Print of the Candidate Signature of the Candidate

I, the parent / guardian of the applicant hereby declare that I am aw are of the financial obligation of admitting my child / w ard to
K.I.M.S.D.U., Karad. I agree to pay the tuition and other fees payable to the institution as fixed from time to time as per the rules of
K.I.M.S.D.U., Karad. I also affirm and endorse the declaration made above by my child / w ard.
Place :
Date : Signature of the Pare nt /
Guardian

http://cet.net.in/kims2015/KAIET15_Report.asp 1/2
5/12/2015 KIMS UNIVERSITY KAIET-2015

Authe ntication by the colle ge w he re the candidate has las t s tudie d/appe are d or by Gaze tte d office r.

Mr./ Miss. ............................................................................................................... born on ............................. w as a bonafide student of this


institute / is know n to me since last .................. years and has passed/appeared his / her examination held in Month.............Year .........

Signature and Se al of the He ad of the Ins titution / Gaze tte d Office r

http://cet.net.in/kims2015/KAIET15_Report.asp 2/2

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