ISHWAR Institute of Prosthetics & Orthotics

AA23(FF),3rd street,3rd Main Road,Anna Nagar,Chennai-600040

The Tamilnadu Dr. M.G.R. Medical University

Application Form for Admission to
BPO Course for the Academic Year .....

Registration No..................(for office use only)

(ALL ENTRIES IN BLOCK LITTERS ONLY)

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Student Candidate.

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First Name

Middle Name

Last Name

Sex (Select from dropdown menu)*

Age (Completed Yers)

Father's Name

Mother's Name

Date of Birth (DD/MM/YYYY)

Place Of Birth

Nationality

Religion

Mother Tongue

Category

Permanent Address

City

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Pincode

Correspondence Address

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Pincode

Mobile No 1

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Email Id

Identity Card Number

Details of Educational Qualifications

Course Last Studied (Select)

Year of Passing (select)

College where studied (Pl. Type)

% age Marks (select range)

Marks obtained in 12th Grade/Equivalent Examination

Subject Marks Obtained Maximum Marks %age of Marks
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Total Marks

Marks obtained in English.

Marks Obtained

Maximum Marks

Application Fee Payment Details.

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IMPS/FT/NEFT/DD/Cheque No.

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10th Marks Sheet

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12th Marks Sheet

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10th Certificate

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12th Certificate

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Transfer Certificate

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Migration Certificate

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Community Certificate

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Others Document

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Any other relevant information to furnish after list of enclosures column.

Undertaking :

I hereby solemnly & sincerely affirm that I fulfill the eligibility conditions & that the statements made & information furnished in this application form are correct. Also, I have not witheld any information. If it is later found that any information furnished herein is fraudulent,incorrect or untrue, I am liable to prosecution and that my admission to the programme is liable to be cancelled. I agree to abide by the rules,terms & regulations as contained in the admission bulletin and other provisions notified by the University. I am also aware that my admission is provisional and is subject to verification of my eligibility. I further declare that during the entire programme in the Univesrity/College I will not indulge in ragging.

I Agree

Signature of the Parent / Guardian

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Signature of the Applicant

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Date

Place

Have Any Query- mail to iipo@ishwarngo.com


The Principal
ISHWAR Institute of Prosthetics & Orthotics
AA23(FF),3rd street,3rd Main Road Anna Nagar,Chennai-600040