APPLICATION FORM FOR COMMON ENTRANCE TEST
FOR PONDICHERY PRIVATE MEDICAL COLLEGES (CETPPMC 2010)
(PONDICHERRY LINGUISTIC AND RELIGIOUS MINORITY MEDICAL AND DENTAL COLLEGES WELFARE ASSOCIATION)
(Reg.No.120 of 2004)
(2011-2012) / Affix attested
Recent
Passport
Or Stamp Size
Photograph here

Application No. Registration No.

(Office use only)

1. Name (in Block Letters):

2. Name of Father / Guardian :

3. Date of Birth:

Age as on 31st Dec.2011

4. Address for Communication:

PIN CODE

Ph.No..with STD Code

5. Religion / Caste:

6.SC/ST/MBC/BC/Others:

7. Details of Qualifying Examination:

Course / Month & Year of
Passing / Institution / Number of attempts / Percentage of Marks
HSC/Intermediate

COMMONENTRANCETESTFORPONDICHERRY PRIVATEMEDICALCOLLEGE (CETPPMC 2011)

HALL TICKET

Affix attested
Recent
Passport
Or Stamp Size
Photograph here

Registration No.

(Office Use Only)

Name of the Candidate:

Test Centre:

Time Schedule: 02-07-2011 .. 10.00 a.m. to 12.00 Noon (Physics & Chemistry)

02.00 p.m. to 04.00 p.m. (Botany & Zoology)

Address of the Candidate:

Signature of the Candidate

CONVENOR

(CETPPMC 2011)

8. Marks in Qualifying Examination: (HSC/Intermediate)

Subjects / Month & Year of Passing / Max.Marks / Min.Marks / % of Mark
English
Physics
Chemistry
Botany
Zoology
Biology

Note: a) Candidate should read the information bulletin before filling up the application.

b) Attested copy of the Marks Statement should be attached with the application.

c) Mere appearance to the Entrance Test will not entail admission to course of study.

The candidate have to satisfy the admission criteria.

PIMS / SMVMCH / SVMCH&RC

9. Name of the Centre where the students desires to write

the Common Entrance test Tick ( ) whichever is

applicable:

PIMS ; Pondicherry Institute of Medical Sciences, Pondicherry

SMVMCH : SriManakulaVinayagarMedicalCollege & Hospital, Pondicherry

SVMCH&RC : SriVenkateshwaraaMedicalCollegeHospital & Research Centre, Pondicherry.

Amount / Bank
D.D.No. / Date:

10. Details of Demand Draft towards Exam.Fee/Cash paid:

11. Joint Undertaking by the applicant and the Parent/Guardian:

I, ……………………………………, son/daughter of ………………… hereby solemnly declare that the information furnished and the statements given and the enclosures are true, correct, complete and no relevant fact is suppressed. I, further declare that if any information found to be false at a later date on verification, I will be liable to forfeit seat and / or removal from the rolls of the institution at whatever stage of study may be, besides making liable for criminal prosecution. I shall abide by the rules and regulations of the admission and the college to which get admitted to.

Station:

Date: Signature of the Applicant Signature of Parent / Guardian

IMPORTANT NOTE

  1. Hall Ticket is an important document without which you will not be permitted to take up the test.
  1. Candidates presenting themselves 30 minutes after the commencement of the Examination shall not admitted into the Examination Hall.
  1. Candidates are requested to bring HB Pencil, Eraser, Ballpoint pen etc.,
  1. The issue of Hall Ticket is an enabling provision for taking up the Common Entrance Test (CETPPMC 2011) under Managemtn Quota and does not mean that the candidate satisfies all the requirements to be eligible for seeking admission to the respective course. The decision on the eligibility of the candidates for admission to the course entirely rests with CETPPMC authorities.
  1. Possession of any incriminating material inside the hall or communicating / gesturing with any other students inside/outside of the hall will be viewed very seriously.
  1. Cell Phones are not allowed inside the Examination Hall.