Download KPC MBBS Application Form

Download MBBS application form 2016 – 2017

INFORMATION SHEET

Candidates are to read the following instructions with utmost care before filling up
the application form and applying for the 1st year MBBS Degree course
Application Form should be filled up with a BLACK BALL POINT PEN ONLY in
Block Letters except the e-mail id and the signature. All letters should be clearly
legible and there should not be any over writing.
No space for relevant information should be left blank.
Recent passport size photograph, captured not before 01/01/2015 with the name
and date mentioned in the photograph itself, with signature at the space below,
should be used in the application form.
Applicants are directed to enclose a self addressed envelope (11”x 5”) with the application
form. Admit Card will be dispatched by “SPEED POST’ to the respective candidates. If any
candidate fails to receive the admit card by 30.06.2015, they are requested to collect the
‘Duplicate’ Admit Card from the ‘Admission Cell’ of the College on 03.07.2015 between
9.00 a.m and 5.00 p.m and on 04.07.2015 between 9.00 p.m. and 1.00 p.m. Admit Cards
will be issued on those days only exclusively to those candidates personally on production
of valid photo ID.
Admit card will not be issued to any other person except the candidate.
The following self attested photocopied documents must be submitted along with
the application form:-
a) Valid age proof certificate.
b) Copies of Mark sheets (10+2)
The various stipulated dates and times mentioned in the Admission Notice,
Application Form and Admit Card are generally fixed ones and cannot be normally
changed.
Applications sent by POST should be sent sufficiently ahead of time so as to REACH
the College Office (Admission Cell) positively within the last date and time;
otherwise, these cannot be entertained.
Utmost care shall have to be taken by the candidates in clearly and rightly filling
up their application forms with all requisite documents without fail.
No application will be entertained which is found incomplete/ incorrect/deficient/
defective in any respect. Such applications are liable to be rejected and there shall
normally be no scope for the erring candidates for any rectification/correction of
their respective applications. Generally, no further communication in this regard
will be entertained.
• Candidates will not be allowed to carry any electronic gadget like calculator/mobile
phone etc. in the examination hall.
Any instance of indiscipline/impersonation/malpractice or adopting
Unfair means will lead to immediate disqualification of the candidature of person(s)
charged with such activity.
 DOWNLOAD MBBS APPLICATION FORM 2016
KPC MEDICAL COLLEGE & HOSPITAL,JADAVPUR
KOLKATA, WEST BENGAL
APPLICATION FORM FOR MBBS COURSE
ACADEMIC SESSION 2015-16
FOR OFFICE USE ONLY
ROLL NO         MBBS/15-16/   APPLICATION NO  APP/15-16/
To Be Filled with Black Ball Point Pen Only. Write in CAPITAL
NAME          Mr./Miss./Mrs.    Paste recent Passport size Photograph taken Not before 01.01.15 (see instruction)
SEX MALE/FEMALE
DATE OF BIRTH  ___/____/_____
AGE :  (As on 31/Dec/2015) (DD/MM/YYYY)
NATIONALITY
Signature
E-MAIL ID
PARENT/GUARDIAN DETAILS
NAME
OCCUPATION
MOBILE NO.
TELEPHONE NO.
(WITH STD)
E-MAIL
RESIDENTIAL ADDRESS
PRESENT ADDRESS
PIN CODE
PERMANENT
ADDRESS
PIN CODE
N.B :- Application form, incomplete and / or defective in any respect is liable to be rejected.
DETAILS OF H.S. OR EQUIVALENT EXAMINATION 
NAME OF BOARD/UNIVERSITY
MONTH & YEAR OF PASSING OF THE

QUALIFYING EXAMINATION

MONTH/YEAR : __________/_______________
SUBJECT
PHYSICS
CHEMISTRY
BIOLOGY
TOTAL
ENGLISH
FULL MARKS
MARKS OBTAINED 
(%)
Details of Attachment :
Copy of the valid age- proof certificate, together with copies of the marksheet of 10 + 2 duly self attested are to be
attached with the application.
DETAILS OF DEMAND DRAFT
D.D.NO .
IN FAVOUR OF
KPC MEDICAL COLLEGE & HOSPITAL,JADAVPUR PAYABLE AT KOLKATA.
AMOUNT IN RS.
7500/- (Rupees Seven thousand five hundred) only
DATE OF ISSUE
/ /2015
ISSUING BANK NAME
DRAWN ON BRANCH
APPLICANT`S DECLARATION
I wish to apply for admission to the KPC Medical College MBBS course and declare that all the above particulars are true to
the best of my knowledge and belief. I agree that acceptance of this application does not confer on me any right in respect of selection for admission.
Date: …………………….
Thumb Impression (L/R) Signature : ……………………………………
PARENTS/GUARDIANS DECLARATION
I am aware of the financial obligations in my child / ward applying to KPC Medical College & Hospital, Jadavpur and I
undertake to pay the tuition and other fees payable to the institution as per the rules of the institution.I also affirm that my child /
ward shall follow all the rules and regulations as prescribed by the College from time to time..
Date : …………………………
Signature : …………………………………..
_________________________________________________________________________
ADMIT CARD FOR ENTRANCE EXAMINATION FOR MBBS COURSE, 2009
*INSTRUCTIONS TO THE APPLICANT
1. All candidates shall mark answers in BLACK BALL POINT PEN only, Answers once marked can not be changed.
2. No electronic gadgets including cell phone shall be allowed in the examination hall
3. Bring this admit card with you, without which you are not allowed to appear in the examination.
4. Test Pattern :Physics-30 questions,Chemistry-30 questions,Biology-60 questions.
5. Questions will be MCQ type and there will be no negative marking.
ADMIT CARD FOR ENTRANCE EXAMINATION FOR MBBS COURSE, 2015
KPC MEDICAL COLLEGE & HOSPITAL, JADAVPUR
1F RAJA S.C.MULLICK ROAD, JADAVPUR, KOLKATA : 700032
OFFICE COPY
ROLL NO :MBBS/15-16/
Exam Date & Time
Paste recent Passport
size Photograph taken
Not before 01.01.15
(see instruction)
05/Jul/2015
12.00 NOON –
2.00 PM
NAME :
ADDRESS :
Reporting Time
Venue : KPC MEDICAL COLLEGE
1F, Raja S.C.Mullick Road, Jadavpur Kolkata- 700032
10.00 AM
Signature
Candidate’s Signature
Signature of the issuing authority
Invigilator’s Signature
(Please write the name and full address of Candidate in Capital Letters.)
ADMIT CARD FOR ENTRANCE EXAMINATION FOR MBBS COURSE, 2015
KPC MEDICAL COLLEGE & HOSPITAL, JADAVPUR
1F RAJA S.C.MULLICK ROAD, JADAVPUR, KOLKATA : 700032
APPLICANT COPY
ROLL NO :MBBS/15-16/
Exam Date &
Time
Paste recent Passport
size Photograph taken
Not before 01.01.15
(see instruction)
05/Jul/2015
12.00 NOON –
2.00 PM
NAME :
ADDRESS :
Reporting Time
Venue : KPC MEDICAL COLLEGE
1F, Raja S.C.Mullick Road, Jadavpur Kolkata- 700032
10.00 AM
Signature
Candidate’s Signature
Signature of the issuing authority
Invigilator’s Signature
(Please write the name and full address of Candidate in Capital Letters.)