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  FILL ONLINE APPLICATION FORM

UPCAT - DENTAL APPLICATION FORM

Fileds indicated with (*) are compulsory
  NAME OF THE APPLICANT (First/Middle/Surname) *
 (Max. 32 characters)
  FATHER'S NAME *
 (Max. 29 characters)
  GENDER *
  
  CATEGORY *
         
  CITIZENSHIP *
    
  TELEPHONE NUMBER, IF ANY
STD CODE (don't prefix with 0 or +91 in STD Code, Eg. Delhi Code=11 )             PHONE NUMBER
                                                                        
  MOBILE NUMBER, IF ANY (Eg. 9999877896, don't prefix with 0 or +91)
         
  PERCENTAGE OF MARKS IN Physics + Chemistry + Biology (10+2) *
  rounded off (eg. 74.5% = 75%, 74.3% = 74%)
  PERCENTAGE OF MARKS IN English (10+2) *
  rounded off (eg. 74.5% = 75%, 74.3% = 74%)
  QUALIFYING EXMAINATION *
       
  DATE OF BIRTH *
  PREFERENCES OF COLLEGE(S) / INSTITUTION(S) WHERE ADMISSION IS TO BE SOUGHT *
FIRST
SECOND
THIRD
  CHOICE OF TEST CENTER CITY CODES *
FIRST SECOND THIRD
  UPLOAD PHOTO * (Passsport Size Only)
  ADDRESS (DO NOT REPEAT YOUR NAME HERE) *
First Line  (Max. 22 characters)
Second Line  (Max. 22 characters)
Third Line  (Max. 22 characters)
Fourth Line  (Max. 22 characters)
Pin Code  (Max. 6 characters)

Note 1: Please note that the form is not complete till payment has been made successfully.

Note 2: If the application is incorretly filed in any manner then the same will be rejected and no claims shall be entertained for the fees against the application form.