SEAT NO. KATHMANDU UNIVERSITY SCHOOL OF MEDICAL SCIENCES APPLICATION FORM FOR MBBS PROGRAM

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1 SEAT NO. KATHMANDU UNIVERSITY SCHOOL OF MEDICAL SCIENCES APPLICATION FORM FOR KUMET 2013

2 CHECKLIST FOR DOCUMENTS TO BE ENCLOSED (Photocopies only) Mark sheet of the qualifying examination and other transcripts Birth certificate or an examination certificate or character certificate showing date of birth 3 passport size photographs Citizenship Certificate. General Instructions 1. Applicants must complete the application form with their recent passport size photograph. 2. Applicants should submit completed application along with the bank voucher of Rs. 2,000/- to any one of the following colleges/address as published in the admission notice. 3. Copies of original transcripts (high school o nwards), birth certificate or character certificate showing the date of birth & citizenship certificate should be submitted along with the application form. 4. Applicants who do not appear in the Entrance Test conducted by the University will not be eligible for admission. Correspondence All correspondences relating to admissions should be addressed to: Kathmandu University, School of Medical Sciences Dhulikhel Hospital, Dhulikhel P.O. Box Kathmandu, Nepal Tel # : (011) Fax # : Website:

3 KATHMANDU UNIVERSITY SCHOOL OF MEDICAL SCIENCES Passport size photograph to be attached here Application for the MBBS Program 2013 (To be filled in by the applicant in block letters) For office use only Form No.: Date received Document checklist I.Sc. or 10+2 SLC Cha.C CC BV B.Sc. PCBE marks % Aggregate marks % Remarks Cha.C= Character Certificate, CC = Citizenship Certificate, BV= Bank Voucher GENERAL INFORMATION 1. Name surname first name other name(s) 2. Sex male female 3. Date of birth / / day month year (A.D.) 4. Place of birth town/village district country 5. Name of a) father _ b) mother 6. Name of guardian (if other than father) 7. Relationship of guardian to applicant 8. Address for correspondence 9. Phone (R) Mob 10. Permanent address 11. Citizenship

4 EDUCATION 12. List all schools and colleges/universities attended Institution Address Date attended 13. Qualifying examination I.Sc or equivalent Examination Year Marks Subjects letter grade percentage I.Sc 10+2 A Level Physics Chemistry Biology Total aggregate % 14. Have you taken courses at KU before? Yes No If yes, please indicate (a) Course (b) Registration No. 15. Declaration by applicant I wish to apply for admission to the KU and affiliated Medical Colleges under KU. I declare that to the best of my knowledge and belief, the above particulars are true. I agree that registration of this application does not confer any right on me in respect of selection for admission, which was solely left to the discretion of the university and college. I have gone through the instructions for admission carefully, and I undertake to abide by all the conditions. I further agree, if admitted, to confirm to the rules and regulations at present in force or that may hereafter be made for the administration of the university and college. I undertake that so long as I am student of the college, I will not do anything unworthy of a student of the college of anything that will interfere with its orderly working and discipline. I am aware that the management has the full authority to take action, including expulsion for disinterest in studies, misbehaviour and frequent failure. Applicant's signature Date 16. Declaration by parent/guardian I hereby declare that I am aware of the financial obligations of applying to and studying at the MBBS/BDS Program and I can afford and undertake to pay the tuition and other fees payable to the institution under its rules. I also affirm and endorse the declaration made above by my ward. Signature of parent/guardian Date

5 KATHMANDU UNIVERSITY Undergraduate Program KUMET 2013 Admit Card Name of the Candidate Entrance Test Details: Seat No. : Date : Saturday, 7 September 2013 Time : a.m. to 12:00 noon Venue : (N.B. Please bring this copy at the time of entrance test and submit to the invigilator.) KATHMANDU UNIVERSITY Undergraduate Program KUMET 2013 Admit Card Name of the Candidate Entrance Test Details: Seat No. : Date : Saturday, 7 September 2013 Time : a.m. to 12:00 noon Venue : (N.B. Keep this copy safely. You will have to produce it during your interview at medical college.)