NORTH EASTERN INDIRA GANDHI REGIONAL INSTITUTE OF HEALTH AND MEDICAL SCIENCES, SHILLONG (An Autonomous Institute, Ministry of Health and Family Welfare, Government of India) Mawdiangdiang, Shillong, Meghalaya REPRINT APPLICATION FORM FOR ENTRANCE EXAMINATION FOR ADMISSION TO PG (MD/MS) COURSE IN NEIGRIHMS, SHILLONG, MEGHALAYA FOR THE SESSION 2015-16

1. Name of Applicant as entered in the     X/XII Standard Marks Statement * :
2. Date of Birth * :     (dd/mm/yyyy)
DECLARATION BY THE CANDIDATE : I hereby declare that I am an Indian National and particulars given above are correct. In the event, any information furnished by me is found to be incorrect/false before or after the Entrance Examination or the Application is incomplete in any respect, the Authority conducting the Entrance Examination or the Government of India can cancel my candidature or selection or admission as the case may be, and action may be taken against me as deemed fit. I undertake to submit all the required certificates/documents in original in support of eligibility like domicile status (PRC), date of birth and educational qualification etc. at the time of counseling and during the admission process as per rule, failing which, my claim of selection against the category shall be forfeited.
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