AtutBandhan

Application For Financial Assistance

(Only Govt Medical College & AIIMS Student To Apply)

(A.) Personal Information: *

1. Name: *

2. DOB: *

3. Mail ID: *

4. Contact No.: *

5. Gender: *

6. Social Category: *

7.Differently abled : *

(B.) Academic Information: *

1. Past Performance

sl.no	Class	University/Board	Year of Passing	Percentage of Mark
(i)	X
(ii)	XII

2. NEET Information

(i)Year of Examination: *

(ii)Mark Obtained: *

(iii)Rank (all India): *

(iV)Rank (all Odisha): *

3. Medical College Information

(i)Name of College: *

(i)Please Enter College Name: *

(ii)Year Of Addmission: *

(iii)MBBS Course Period: *

(C.) Family Information: *

1. Name Of Father: *

2.Profession: *

3.Name Of Mother: *

4.Profession: *

5.Contact No Of Father/Family: *

6.Annual Income of Family/Father in INR:*

4. Details Of Siblings

Name :

Gender:

Age(Years):

Present Status/Occupation:

Annual Income If Any:

Sl.no	Name	Gender	Age	Present Status/Occupation	Annual Income(If Any)	Action

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About Us

Contact Info

Apply for Assistance

Application For Financial Assistance

1. Past Performance

2. NEET Information

3. Medical College Information

4. Details Of Siblings

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