Rajiv Gandhi University of Health Science, Karnataka4th 'T' Block, Jayanagar, Bangalore-560041EXAMINATION APPLICATION FORMEligibility of the candidate should be checked by the PrincipalNationality :Quota : CET / MGTCourse : M.B.B.S. (RS3)-PHASE - I Examination:Jun-15Name of the College :M.S. RAMAIAH MEDICAL COLLEGE, BANGALORE College Code:M005Register No. : 14M0395 Application No. : 20150020873Date :12-06-15Candidate Name : ASISH.B.GEORGEGroup : GMDate of Birth & Age : Gender : MPresent Address & Permanent AddressTel No& Tel NoI-YearSubject QPCode Conducted Attended %ANATOMY-TP1 1075ANATOMY-TP2 1076PHYSIOLOGY-TP1 1077PHYSIOLOGY-TP2 1078BIOCHEMISTRY-TP1 1079BIOCHEMISTRY-TP2 1080To Be Paid FeesExam App Marks Exam PDC+Convocation(Exam Fees is calculated for each Processing200Card300Fees 4500+Dessertion Fees0 appearing QPcode)Fees FeesActual Paid FeesExam AppMarks Exam PDC+Convocation Fine TotalProcessing _____ Card______ Fees_____+Dessertion Fees____ Fees______ Fees _______FeesFeesFee Receipt No ______ Fee Receipt Dt-------------------------Remarks:Signature of the Student : Signature of the PrincipalDate : 12-06-15with college / seal