CENTRAL BOARD OF SECONDARY EDUCATION

Click Here to Print This Page

Home

CONFIRMATION PAGE - AIPMT- 2016

Application / Registration No.

7405075

You have successfully submitted On-line Application. Please preserve this page along with proof of fee payment for future reference.
C andidate's Name

A BHIRA M K V

Date of Birth

16/10/1997

Mother's Name

P RA JI

Gender

Male

Father's Name

VINOD

C ategory

UR

Year of Passing/Appearing C lass

XII

2015

Person with Disability

No

State/C ountry to which Applicant

belongs

Kerala

Nationality

Indian

Question Paper Medium

English

C lass XII Marks(%)

82.2

Mobile No.

91-9496682738

Email Id

abhiramkv1997@gmail.com

C hoice of Exam C entres

(1) TRIVA NDRUM ( 620)

(2) ERNA KULA M ( 618)

(3) KOZHIKODE ( 619)

(1) 1st State : NA

(2) 2nd State : NA

(3) 3rd State : NA

(4) A LL India: Yes /( UR )

(5) Participating UNIV./INST. :

(6) A FMC : Yes
Yes

Option For Seats/Eligible C ategory

DECLARATION: - I hereby solemnly and sincerely affirm that all the particulars stated by me in the Application Form are true and correct. Even the
spelling of names and category is correct. I have not concealed any information. However, if any information furnished herein is found fraudulent,
incorrect or untrue, I understand that I will be liable for criminal prosecution and I also agree to forego my candidature/seat. Further that the selection
and admission to the course is liable to be cancelled. I agree to abide by the Rules and Regulations governing the Examination as contained in the
Information Bulletin for AIPMT-2016 which I have gone through carefully. I further declare that I have not submitted any other application for AIPMT2016 and mobile no and email address given in the form are correct and my own or of my parents'.

Signature

Right Hand Index Finger Impression

Photo
Complete mailing address:
Address

KOKKATTAZHIKATHU, PANAVELY P O

C ity

KOTTARAKARA

State /C ountry

Kerala

Pin C ode

691532

Details of Transaction.
Transaction ID:129483

Amount:1400

Date of Deposit :20160101

Bank Name :Syndicate Bank

Bank Office Name & Address:NA( micr code : NA), ,

Registration No:

7405075

Printed On : 01/01/2016