Name of the Technology: Diploma Medical Science (D.M.S.)

Permanent Address

Present Address

General Qualification (Fill up the table) :

Passed School/College Group Grade Average Point Year

In case emergency whom to contract:

Dear Sir,
I am candidate of Diploma Medical Science (D.M.S.) in your Institute . I wiah to complie for the Diploma Medical Science (D.M.S.) training programme. I promise that I will follow & adhere faithfully to Institute rules and regulation.