SNIMS - Sankar Narayana Institute of Medical Sciences

SANKAR NARAYANA INSTITUTE OF MEDICAL SCIENCES
TIRUPATHI-MADANAPALLI-CHITTOOR-KADIRI-ANANTHAPUR

ONLINE STUDENT REGISTRATION FORM

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Session

Place

Name of the Candidate

(In Block Letters as SSC)

Father/Husband /Guardian Names

Date of Birth (As per SSC)

Educational Qualification

(With SSC Register No)

Nationality & Religion

Caste & Sub-Caste

a) Annual Income

b) Occupation of the Parent

Present Address

Permanent Address

10.

a) Mobile No.

b) Phone No.

11.

Certificate Enclosures:

SSC Marks Memo

Transfer Certificate

Study and Conduct

Caste/Income/Nativity Certificates

Ration Card

Passport size photos black&white - 10

DECLARATION OF THE CANDIDATE

I submit that all the particulars given in this form are true to the best of my knowledge. In the event of any information being proved in correct. I agree to the rejection of my application if already admitted, discontinuance and or decision taken by the Director/Principal.

Place:

Date:

Signature of the Candidate

Signature of the Parent

For Office use only

Admission No.	Registration No.	Signature with date