Centac - Govt. Of Puducherry.pdfviyaskiddo.pdf 4p4n4u

6/5/2019

CENTAC - Govt. of Puducherry

CENTRALISED ISSION COMMITTEE Government of Puducherry APPLICATION FORM FOR ONLINE CENTAC ISSION - 2019 - 20 APPLICATION NUMBER

:

80100266

UG NEET Courses (M.B.B.S., B.D.S., B.A.M.S., B.V.Sc.)

Personal Details Applicant's Name:

C VIYASAVARTHAN

Father's Name

COJANTHAVELOU@VEERAPPAN

Gender

MALE

Date of Birth

23-08-2000

Nationality

INDIAN

Religion

HINDU

Are you Puducherry Residence (Having residence certi cate issued by the Govt. of Puducherry)

YES

Region

PONDICHERRY

Category

SC

Special Category

Not Applicable

Address Details Email-id

[email protected]

Mobile Number

9791709943

Alternate Number

9600519779

Permanent Address

43,44,Pangajam nagar ,Abishegapakkam ,Pondicherry, 605007.

Communication Address

43,44,Pangajam nagar ,Abishegapakkam ,Pondicherry, 605007.

Academic Data Entry APPLIED FOR

MBBS,BDS

HSC Registration No

1811759646

HSC Board Name

Tamil Nadu Board

HSC Result



HSC Marks Subjects :

Marks :

LANGUAGE

ENGLISH

MATHEMATICS/MATHEMATICS I

PHYSICS

CHEMISTRY

BIOLOGY

157

149

112

119

130

097

Payment Details Payment Mode:

ONLINE PAYMENT

Amount Paid :

 500.00

Amount Total :

 500.00

Payment Transaction No :

31861558195672

https://centauducherry.in/neet/application_view

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CENTAC - Govt. of Puducherry

Payment Status :

SUCCESS

Attachments Attached File

ed

View

HSC Certi cate

Yes

HSC Certi cate

PIC Certi cate Front Page

Yes

PIC Certi cate Front Page

PIC Certi cate Back Page

Yes

PIC Certi cate Back Page

Regional Certi cate

No

NRI Certi cate

No

Rural Certi cate

No

COURSE PREFERENCE DETAILS Preference No

Course Name

1

[GQ] - IGMC&RI GOVT MEDICAL [M.B.B.S.] - Medicine

2

[GQ] - PONDICHERRY INSTITUTE PIMS [M.B.B.S.] - Medicine

3

[GQ] - MANAKULA VINAYAGAR MEDICAL [M.B.B.S.] - Medicine

4

[GQ] - VENKATESWARA MEDICAL [M.B.B.S.] - Medicine

5

[MQ] - PONDICHERRY INSTITUTE PIMS [M.B.B.S.] - Medicine

6

[MQ] - MANAKULA VINAYAGAR MEDICAL [M.B.B.S.] - Medicine

7

[MQ] - VENKATESWARA MEDICAL [M.B.B.S.] - Medicine

8

[GQ] - VENKATESWARA DENTAL [B.D.S.] - Dental

9

[GQ] - MAHATMA GANDHI DENTAL [B.D.S.] - Dental

10

[GQ] - MAHE DENTAL [B.D.S.] - Dental

11

[MQ] - MAHE DENTAL [B.D.S.] - Dental

Declaration :  I hereby declare that I have carefully read the Prospectus and the Non-Disclosure agreement. All the particulars stated in this application form are true and correct to the best of my knowledge and belief. If any of these information provided is found false/ incorrect, I shall abide by the actions and decisions taken by the CENTAC

Signature

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