Online MDS Form

Date R. No
The Principal,
Kadrabad, Modinagar 201201


I have the honour to submit my application duly filled along with necessary documents. I request you to consider me for admission into the First Year of the MDS course Speciality in your college in the academic session
    Your's Faithfully
Place (Name Of The Candidate)
Name in Full (in block letters )
Name of Father
Name of Mother
Name of Local Guardian
Local Guardian Occupation, Full Address
Permanent, Full Address inclucding Police Station
Present, Full Address
Landline Number
Mobile Number
Date of birth as recorded in the School Leaving Certificate

Details Of Examination Passed

Bechlor of Dental Surgery :-

Name of College
Name of University
Year of Passing

No. of attempts :

% of marks

No. of attempts :

First Year BDS
Second Year BDS
Third Year BDS
Final Year BDS
Internship Completed on
Form College

Marks Obtained Subject Wise

Subject Subject Subject  
1st year BDS
2nd year Bds
3rd year BDs
Final year

Pathology &
Gen. Medicine

Oral Medicine & Radiology
Public Health Dentistry
Physiology & Biochemestry

Oral Anatomy 
Dental Mateirals

Gen. & Dental Phermacology

Gen. Surgery Oral Pathology Community Dentistry  
Oral Surgery Pedodontics Orthodontics
Conservative Dentistry Periodontology Prosthodontics
Over All percentage Of BDS
Hostel Accommodation

NEET Details

Roll Number
% Obtained
I mr /Ms.              Son /of dougher of Shri / Smt.   Permanent residion   . do hereby declare that, if selected for admission, I shall abide by the Rules/Regulations as framed by the Institute/affiliating University and maintain discipline in the college/hostel and shall not indulge in any unfair act, It is further affirmed that violation of rules/regulations, as above shall make me liable to disciplinary action as may be awarded by the college authority.

Counter name of
Parents/Local Guardian
Name of Candidate