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Candidate Basic Details
Candidate's Full Name  
Gender  
Date of Birth  
Age (as on 11/01/2018)
Physically Handicapped
Type of Handicapped
Candidates Mobile No  
Candidate's Email Id  
Candidates Marital Status
Father Name  
Mother Name  
Nationality  
Community  
Category  
Cast Name  
Birth Place  
State of Eligibility
Occupation Nature of Father/ Mother  
Father/ Mother Designation  
Present Postal Address  
Parent's Contact Details
Parent Landline No  
Parent Mobile No  
Parent Email Id  
Family Annual Income  
Details of qualifying examination passes on the basis of which is sought
Exam/ Degree  
Name of Board/ University  
Roll No  
Year & Month of Examination

 
 

Class/ Division  
Name of Institute last attended  
Place of Institute  
   
 
Rank in the All India Entrance Exam( Through which admission to AIIMS is given)
All India Rank(Common Rank of Candidates)  
Category Rank  
Local Guardian details
Name  
Relationship  
Occupation  
Address  
Landline(With STD code)  
Mobile No  
Email ID  
Wheteher Candidate was a member of NCC/NSS  
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