Association Application Form

SHEKHPARA EAJPUR, 24 PGS (N), W.B., 743424

WEST BENGAL ELECTROPATHY
MEDICAL COUNCIL

To
The Registrar,
Sir / Mam,

I request you kindly register as a student of Course :

year of :

under these council particulars of the student is given below.

Name Of The Student (Block Letter) :

Father’s / Husband Name :

Mother’s Name:

Permanent Address Village / Ward :

P.O :

P.S. :

Dist :

Pin :

State :

Date of Birth :

Age :

Sex :

Cast :

Religion :

Aadhaar Card No :

Nationality :

Educational Qualification :

Mobile No :

Email ID :

Institute name :

Aadhar Card Both Side :

Choose File

Photo :

Choose File

Signature Of Candidate :

Choose File

Final Registration Certificate,

Choose File

Final Identity Card :

Choose File

Free Deposit Receipt :

Choose File

All Mark sheet for medical, Internship certificate., Student Identity card your Medical college.

Student should follow the rules and regulation of the council.