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    Kims University Kaiet-2015.PDF 11111

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    Patricia Joseph
    Pooja Kakade applied for admission to the MBBS program at Krishna Institute of Medical Sciences Deemed University. She is from Washim, Maharashtra and completed her application form on May 12, 2015. She paid an application fee of Rs. 1500 via a demand draft. Pooja declared that all information provided in her application is true and agreed to abide by the rules and regulations of the university if admitted. Her father Babanrao Kakade also signed to acknowledge the financial obligations of admitting Pooja to the university and endorsed her application.

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    Kims University Kaiet-2015.PDF 11111

    Uploaded by

    Patricia Joseph
    54 views2 pages
    Pooja Kakade applied for admission to the MBBS program at Krishna Institute of Medical Sciences Deemed University. She is from Washim, Maharashtra and completed her application form on May 12, 2015. She paid an application fee of Rs. 1500 via a demand draft. Pooja declared that all information provided in her application is true and agreed to abide by the rules and regulations of the university if admitted. Her father Babanrao Kakade also signed to acknowledge the financial obligations of admitting Pooja to the university and endorsed her application.

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    Pooja Kakade applied for admission to the MBBS program at Krishna Institute of Medical Sciences Deemed University. She is from Washim, Maharashtra and completed her application form on May 12, 2015. She paid an application fee of Rs. 1500 via a demand draft. Pooja declared that all information provided in her application is true and agreed to abide by the rules and regulations of the university if admitted. Her father Babanrao Kakade also signed to acknowledge the financial obligations of admitting Pooja to the university and endorsed her application.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    54 views2 pages

    Kims University Kaiet-2015.PDF 11111

    Uploaded by

    Patricia Joseph
    Pooja Kakade applied for admission to the MBBS program at Krishna Institute of Medical Sciences Deemed University. She is from Washim, Maharashtra and completed her application form on May 12, 2015. She paid an application fee of Rs. 1500 via a demand draft. Pooja declared that all information provided in her application is true and agreed to abide by the rules and regulations of the university if admitted. Her father Babanrao Kakade also signed to acknowledge the financial obligations of admitting Pooja to the university and endorsed her application.

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    5/12/2015 KIMS UNIVERSITY KAIET-2015

    KRISHNA INSTITUTE OF MEDICAL


    SCIENCES DEEMED UNIVERSITY Application
    (Declared U/s of UGC Act, 1956 vide notification No.F.9-15/2001-U.3 of Ministry of Human No.
    Resource Development, Govt. of India)
    Karad, Dist.Satara (Maharashtra State), Pin: 415110
    Phone: (02164) 241555/6/7/8, Fax: (02164) 243272/242170 1411140
    WebSite: www.kimsuniversity.in
    KAIET - 2015 APPLICATION FORM for
    (MBBS & BDS)

    Course Preference: MBBS

    Candidate's Name : KAKADE POOJA BABANRAO

    Father's/Mother Name : BABANRAO SURYABHAN KAKADE

    Date of Birth : 23/08/1995

    Gender : Female

    Address : DATTA NAGAR LAKHALA WASHIM


    Paste Your Recent Color
    TQ. DIST.WASHIM Photograph as per the
    instructions in the
    MAHARASHTRA
    brochure.
    City : WASHIM Pin : 444505

    State : MAHARASHTRA

    Mobile Number : 9763282177 Tele. No. : 07252-233977

    Category : OBC

    Choice of Centre : 14-NAGPUR


    Signature of the Candidate
    Email : santosh456@gmail.com

    Demand Draft Details : Bank : BANK OF MAHARASHTRA

    D.D. No : 881739 D.D. Amount : Rs. 1500/- D.D. Date : 12/05/2015

    De claration

    1. I hereby declare that the above information is true and complete to the best of my know ledge. I am aw are that if any
    information herein is found to be incorrect or incomplete, my application form w ill be rejected / admission w ill be cancelled.
    2. If admitted to this Institution I shall abide by its Rules & Regulations.
    3. I have read and understood all the provisions contained in the brochure and hereby agree to abide by these provisions.

    Le ft Thum p Print of the Candidate Signature of the Candidate

    I, the parent / guardian of the applicant hereby declare that I am aw are of the financial obligation of admitting my child / w ard to
    K.I.M.S.D.U., Karad. I agree to pay the tuition and other fees payable to the institution as fixed from time to time as per the rules of
    K.I.M.S.D.U., Karad. I also affirm and endorse the declaration made above by my child / w ard.
    Place :
    Date : Signature of the Pare nt /
    Guardian

    http://cet.net.in/kims2015/KAIET15_Report.asp 1/2
    5/12/2015 KIMS UNIVERSITY KAIET-2015

    Authe ntication by the colle ge w he re the candidate has las t s tudie d/appe are d or by Gaze tte d office r.

    Mr./ Miss. ............................................................................................................... born on ............................. w as a bonafide student of this


    institute / is know n to me since last .................. years and has passed/appeared his / her examination held in Month.............Year .........

    Signature and Se al of the He ad of the Ins titution / Gaze tte d Office r

    http://cet.net.in/kims2015/KAIET15_Report.asp 2/2

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