APPLICATION-CUM- REGISTRATION

Speciality Preference (i)

Speciality Preference (ii)

Name of the Candidate (in Block letters)

Father’s Name (in Block letters)

Date of Birth

Speciality Preference (iii)

Last Name

Category applied for

Gender

Are you Bonafide Himachali /Domicile

Permanent State Dental Council/DCI Reg. No.

NEET Roll No.

(valid upto)

Marks obtained in NEET-MDS-2020

Name of College (BDS Passed)

Phone

Permanent Address with Pin Code

Himachal Institute of Dental Sciences