APPLICATION NUMBER

2191547

PAYMENT MODE

DD

COURSE GROUP

AMOUNT

1600

COURESES/APPLIED

[MBBS]

DD NUMBER

475069

TEST CENTER

Bangalore,Chennai

DD DATE

11/2/2015

DATE OF BIRTH

21/9/1997

CATEGORY

GENERAL

SEX

Female

NATIONALITY

India

NAME OF THE APPLICANT

V.Swathi

NAME OF THE PARENT/

GUARDIAN

P.Priskilla

ADDRESS LINE 1

No.4,9th east main road,gandhinagar,

ADDRESS LINE 2

NA

ADDRESS LINE 3

NA

PIN

632006

STD CODE/TELEPHONE
NUMBERS

NA

CITY

Vellore

E-MAIL ADDRESS

swathivpriya@yahoo.c om

STATE

Tamil Nadu

MOBILE NUMBER

+918681824365

DATE OF COMPLETION OF
INTERNSHIP

NA

FOR MD/MS
APPLICANTS
ARE YOU A DIPLOMA
HOLDER?

priya

FOR MTECH
APPLICANTS
NA

ARE YOU A GATE SCORER? NO

DECLARATIONS:
I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. I
have read and understood all provisions of admissions and agree to abide by them. I also affirm that I fulfil the eligibility
requirements for the course/s applied. In the event of submission of fraudulent, incorrect or untrue information or
suppression or distortion of any fact, like educational qualification, marks, nationality etc. I understand that my admission/
degree is liable for cancellation. I further understand that my admission is purely provisional subject to the verification of the
eligibility conditions.

NOTE:
1.Please keep a copy of the filled in application for future reference.
2.Application number must be quoted in all future correspondence.
3.The candidates who are appearing for GATE exam should submit the valid score card on or before the last
date of receipt of application (For MTech / MSc Tech applicants only)
4.Please send this completed application form with DD/Challan(if payment is not via Credit Card) to: Director Admissions, Manipal University, Manipal - 576104