Registration No.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA

APPLICATION FORM FOR ADMISSIONS TO M.D/M.S (UNANI) COURSES (2007-08)
NATIONAL INSTITUTE OF UNANI MEDICINE, BANGALORE
Please fill in all the entries in CAPITAL LETTERS with BALL PEN only.
1. Preference(s) of Subject for Admission is compulsory (Write subject codes in the boxes in order of preference)
Subject Options in order Subject
Subject Code
For Office Use
Code of Preference
01 Moalejat I Date of Receiving of Application
02 Ilmul Advia II Fee paid (Rs.)
03 Tahaffuzi wa Samaji Tib III
Signature of Receiving Clerk
04 Ilmul Qabalat wa Amraze Niswan IV
2. Personal Details
Name (Use CAPITAL LETTERS only. Leave a blank box between First, Middle & Last Names)

Date of Birth Age in years Gender Category Mother’s Name

DAY MONTH YEAR As on 31-08-07 1.Male 1.General, 2.In-Service,

2. Female 3.SC, 4.ST, 5.GOI Nominee Nationality

Father’s Name (Use CAPITAL LETTERS only. Leave a blank box between First, Middle & Last Names)

3. Details of Qualifying Examination

Year of Date of
Examination Name of College & Place Board/ University
Passing
% Aggregate
Completion of
I
% Internship
BUMS II

Annual / III
Professional IV
V

4. Details of Fee
Draft No. Date Amount (Rs.) Name of Bank

DECLARATION BY THE APPLICANT

I..............………………………………….……..........S/o or D/o...……………………………………................declare that all
the statements given in this application form are true to the best of my knowledge. I understand that if any of the statements are
found wrong, my admission will stand cancelled. If admitted, I will abide by the rules & regulations in force in NIUM and as
amended from time to time and pay the prescribed fees.

5.Photograph 6.Present Address for Correspondence 7.Permanent Address

Affix latest passport

size photograph duly
attested
DO NOT STAPLE

PIN PIN

Phone No. with STD Code: Signature of the Candidate

Mobile No.
E-mail:
Date:
Place:
 Registration No.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA

HALL TICKET
ENTRANCE TEST FOR ADMISSIONS TO M.D/M.S (UNANI) COURSES (2007-08)
Office Copy
Categories: Tick (√)
Date of Entrance Test: 22/09/2007
General
Time: 10.00 am
Venue of the Test: In-service
National Institute of Unani Medicine, SC Affix latest passport size
Kottigepalya, Magadi Main Road, photograph duly attested
ST DO NOT STAPLE
Bangalore-560091
GOI Nominee
(Deficient States)

Mr/Ms.……………………………….……………………………………………..…………..
Son/Daughter of Mr……………………………………………………………….……………

Options in
S. No. Subject order of
Preference
01 Moalejat
02 Ilmul Advia Signature of Chief Superintendent
03 Tahaffuzi wa Samaji Tib Signature of the Candidate Entrance Test
04 Ilmul Qabalat wa Amraze Niswan

Registration No.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA

HALL TICKET
ENTRANCE TEST FOR ADMISSIONS TO M.D/M.S (UNANI) COURSES (2007-8)
Student Copy Categories: Tick (√)
Date of Entrance Test: 22/09/2007 General:
Time: 10.00 am
In-service
Venue of the Test: Affix latest passport size
National Institute of Unani Medicine, SC
photograph duly attested
Kottigepalya, Magadi Main Road, ST DO NOT STAPLE
Bangalore-560091 GOI Nominee
(Deficient States)

Mr/Ms.……………………………….……………………………………………..…………..
Son/Daughter of Mr……………………………………………………………….……………

Options in
S. No. Subject order of
Preference
01 Moalejat
02 Ilmul Advia Signature of Chief Superintendent
03 Tahaffuzi wa Samaji Tib Signature of the Candidate Entrance Test
04 Ilmul Qabalat wa Amraze Niswan