Apply Online Order Number APPLICATION FORM Select Your Region KARANTAKA OTHERS OVERSEAS Course Stream * UG PG DIPLOMA COURSES * MBBS MD - Physiology MD - Bio-Chemistry MD – Pathology MD - Microbiology MD - Pharmacology MD - Forensic Medicine MD - Community Medicine MD - General Medicine MD - Dermatology , Venereology & Leprosy MD - Psychiatry MD - Paediatrics MS - General Surgery MS - Orthopedics MS - Ophthalmology MS - ENT MD – Anaesthesiology MS - Obstetrics & Gynecology MD - Radio Diagnosis MD - Radiotherapy MD - Hospital Administration MD- Emergency Medicine MD – Pulmonary Medicine Diploma in Dermatology Diploma in Anesthesia Diploma in Child Health Diploma in Obstetrics & Gynaecology Diploma in Psychological Medicine Diploma in Ophthalmology Diploma in Orthopaedics Diploma in Oto-Rhino-Laryngology Diploma in Radio-Diagnosis Personal Information Name * Father's Name * Contact No. * Mother's Name * Contact No. Date of Birth * Email Address * PHONE * Permanent Address * Pin Code GENDER MALE FEMALE Marital Status SINGLE MARRIED Educational Qualification SSLC BOARD * SCHOOL/COLLEGE * AGGREGATE PERCANTAGE * HIGHER SECONDRY BOARD * SCHOOL/COLLEGE * AGGREGATE PERCANTAGE * UG STREAM * SCHOOL/COLLEGE * AGGREGATE PERCANTAGE * Have you written any Entrance Exams? YES NO Entrance Exam * Score * Rank * Declaration Declaration I hereby solemnly and sincerely declare that all the information provided are genuine. I will be responsible and ready to face the consequences for my incorrect or fraudulent information if found any. I am answerable to any of the queries regarding all the documents submitted by me. I am aware that on admission to a particular course, I am obligated to complete the full course. No money will be refunded after a successful admission. If the candidate chooses to cancel the admission or not to join the course, Wayzon Consultancy will not be accountable in any way financially or otherwise. The post-admission service offered by the company is a courtesy and not a liability. I agree to adhere to the rules and regulations of the organization.