Rashtreeya Sikshana Samithi Trust, Jayanagar, Bangalore-560 011
D.A. PANDU MEMORIAL R.V. DENTAL COLLEGE & HOSPITAL
Affiliated to RGUHS & Recognised by D.C.I.
Estd: 1992 CA37, 24th Main, I Phase, J.P.Nagar, Bangalore - 560 078, Karnataka.
Phone No.: 26345754, 26547053, Fax: +91-80-26658411
email: rvdc@vsnl.com Website: http://www.rvdentalcollege.org

    
 
Paste Passport size photograph & sign
 
       

APPLICATION FOR ADMISSION TO I MDS COURSE FOR 2005-06
1. Name of the Applicant
     (IN BLOCK LETTERS)		  
2. Name of the Parent
     (IN BLOCK LETTERS)
   

a) Occupation

 ..........................		  
  b) Annual Income    ..........................
3. Address for Correspondence
     (IN BLOCK LETTERS)		  
Door No./Street  
Town/City  
State  
Country  
PIN Code  
STD Code with Tel.No.  
4. Permanent Address
     (IN BLOCK LETTERS)		  
5.a) Nationality  
   b) Sex    Male / Female
   c) Date & Place of Birth
dd
   
  mm
   
  yyyy
       
 
6. Details of qualifying Examination Passed:
Year of passing BDS Date of completion of Internship Name of the college studied COMED-K PGET 2005 Details
     
   
Reg. No.:  
Rank No.:  
   
M.D.S. Courses offered :
 
  1. Community Dentistry
  2. Prosthodontics
  3. Oral & Maxillofacial Surgery
  4. Conservative Dentistry
  5. Oral Medicine & Radiology
  6. Orthodontics
  7. Pedodontics
  8. Periodontics
 
Preference of speciality :
 
  1. .....................................................
  2. .....................................................
  3. .....................................................
       
    DISCIPLINE DECLARATION    
I, _______________________________ Son/Daughter of _________________________
hereby agree to confirm to the rules and regulations of the College including those relating to the Hostel, if any, laid down or to be laid down hereafter by the Principal of the College or the Management for the due maintenance of discipline at the said College and I further agree to make good, when called upon to do so, any damages to furniture, apparatus or other articles which may be caused by carelessness, negligence or wantonness on my part.		  
Signature of Parent/Guardian   Signature of the Applicant
   
__________________________________________________________________________________
 
OFFICE ORDERS
The Applicant _________________________ Son / Daughter of ____________________ is Provisionally selected for admission to First Year MDS Course during the year 2005 -06
  
   
Date ______________   PRINCIPAL
D.A. PANDU MEMORIAL
R.V. DENTAL COLLEGE
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