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Middle Name *

Last Name *

Email *

Mobile Number *

Gender *

Blood Group *

Parent Mobile *

Parent Email

DOB*

Birth Place *

Birth Place Taluka *

Birth Place District *

Birth Place State *

Religion *

Category *

Caste Name *

Nationality *

Student Aadhar No. *

Father's Full Name *

Mother's Full Name *

Guardian's Full Name(Optional)

Relation with Guardian(Optional)

Father Aadhar No. *

Mother Aadhar No. *

Mother Tongue *

Annual Income of Parent / Guardian *

Parent Occupation *

Hostel *

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Address Info

Present Address

State

Dist

Tal

PIN Code

Same As Above

Perment Address

State

Dist

Tal

PIN Code

Academic Info

University Reg. No.

Batch Year

Academic Year

Course

Course Year

Division

Student Roll No

Admission Categories

Details of Qualifying Examination Passed

Name of Qualifying Examination

Reg. No. / Roll No.

Passing Month & Year

Name of College / School

Board / University Affiliated to

PUC II / HSC Exam Marks

English

Physics

Chemistry

Biology

Total Marks

NEET & Group Percentage Details

NEET Rank

NEET Roll No.

Marks Obtained in NEET

Percentage of Marks Total (%)

Percentage of Marks PCB Group (%)

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Latthe Education Society's

Acharya Deshabhushan Ayurvedic Medical College & Hospital

Affiliated to Rajiv Gandhi University of Health Sciences, Karnataka, Bengaluru & Sanctioned by Govt. of Karnataka, Recognised by NCISM / Ayush, New Delhi

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