WARNING: AN INCORRECTLY/INCOMPLETELY FILLED FORM CANNOT BE EDITED AFTER SUBMISSION. PLEASE ADHERE TO THE FOLLOWING GUIDELINES FOR FILLING THE FORM.
Email address
Subject: Choose from the list
UID: Enter 12-digit Aadhar UID of the UID Authority of India. If you do not have an Aadhar card, apply for the same and enter the 14-digit acknowledgement number of that application.
Name: Enter your full name without prefixing Dr or Dr (Mrs).
Year of Birth
Month of Birth: Choose from the list
Date of Birth
Mobile: Write your active 10-digit mobile number
Address: Write your permanent address along with pincode. Use multiple lines if required.
PG Category: Choose from the list among:
Reservation Category: Choose from the list
Gender: Choose from the list
Preference: Enter 9-letter preference code
UG Degree: Write UG Degree conferred, Name of college, Name of University, year of passing in a single line separated by commas. E.g. MBBS, PMCH, AKU, 2012
UG Marks: MBBS/BDS aggregate marks and Percent. Enter as (4-digit total marks obtained)/(4-digit total full marks)=ab[decimal]cd%. Example: If you have scored 1307 out of 2000 = 65.03%, write 1307/2000=65.03%.
Failures: Add the number of times you have failed in MBBS/BDS examinations. E.g. if you have failed once in 2nd Prof yr and twice in 3rd Prof yr, choose 3.
PG/SS: Choose your postgraduate/superspecialty degree in the subject applied from the list. Only diploma or only MBBS need not apply in any subject including non- and para-clinical subjects.
MD/MS/DNB/MDS: Degree, Institution, University, Period, Duration. Write in a single line separated by commas. E.g. MD (Pathology), PMCH, AKU, 2011-2014, 3 years.
DM/MCh/DNB-SS: Degree, Institution, University, Duration, Period. Write separated by commas in a single line. E.g. MCh (Paediatric Surgery), AIIMS, 2011-2014, 3 years. In case you are a candidate appearing for exams, write (expected) at the end of the line. Write NA if no DM/MCh/DNB-SS degree.
Subject Marks in UG: Marks in the subject (or subject group) during Undergraduate study (MBBS/BDS, not postgraduation) and Percent. Enter as (3-digit marks obtained)/(full marks) = ab[decimal]cd%. E.g. 200/300 = 66.67%
Registration: MCI/Name of state medical council, year of registration, registration number written in a single line separated by commas. E.g. BCMR, 2013, 34030
Present posting: Post, institution, block/city, state, country (if other than India); and issuing authority, notification number, and date in a single line. E.g. MO, PHC Dhanarua, Bihar, Health Dept GoB, 56(2) dated 12 Apr 2015 joined 15 Apr 2015
WorkExp: Work in Government Sector. Overall duration, followed in next lines by serial number in brackets, locations, periods, notification numbers, issuing authority, dates from most recent to oldest. Write None if no such experience.
Previous Tutorship/SR: Enter Department, Institution name, Duration, Period. E.g.: Ophthalmology, PMCH, 2011-2012, 1 year 6 months. Use multiple lines (starting with serial numbers in brackets) for different institutions. If not applicable, write NA.
Spouse: If your spouse is also applying, enter his/her name, subjects applied and 12-digit Aadhar UID. Write NA if not applicable. E.g. Rani Singh, Anatomy, Physiology, XXXXXXXXXXXX.
By clicking on 'Submit,' you agree to declare that "all information submitted in the online and offline forms is true to the best of my knowledge. In the event of submitting false information, my application will be considered null and void ab initio, and I will be liable for disciplinary action."