FPMT-2018 APPLICATIONFORM
FOR ADMISSION TO MBBS/MD COURSE IN FOREIGN TOP MEDICAL UNIVERSITIES
To be filled in CAPITAL Handwriting only
NAME:
FATHER: OCCUPATION:
MOTHER:OCCUPATION:
DateofBirth:SEX:MF ADDRESS:
PASTE RECENT PHOTOGRAPH
PINCODE
STATE:NATIONALITY:
EMAIL: GEN/SC/ST/OBC :
FPMT 2018 PAPER LANGUAGE :MOBILE NO. :
ENGLISHHINDI WHATSAPP NO.:
11TH PASSING YEAR / 12TH PASSING YEAR/APPEARING / APPEARING
IF 12TH PASS THEN MARKS OBTAINEDIN / ENGLISH : / PHYSICS : / CHEMISTRY :
BIOLOGY : / HINDI(OR OTHER) : / Total % :
NEET 2018 SCORE : / CHOICE OF UNIVERSITY (IF ANY):
3 CHOICE OF COUNTRY :
(ANNEXURE 3 BELOW THIS FORM) / TOTAL FEES AFFORDABILITY FOR FULL MBBS COURSE
10-15 LAKHS 15- 20LAKHS 20-25LAKHS 25-40LAKHS
1)IherebydeclarethatIhavebeensubmitthemarksheetcertificateof10th12thwiththisform.
2)IhavereadandunderstoodalltheRulesRegulationsgoverningFPMT-2018.
3)Iherebydeclarethattheaboveinformationistrueandcompletetothebesttomyknowledge.Iam aware that if any information found to be incomplete my application form will be rejected/admission will becancelled.
Place :
Date : SIGNATURE OF CANDIDATE
EMAILTHISFORM SCAN COPYTO
FPMTHELPLINEWHATSAPP:+91-8826926773 , +91-7566936975
ANNEXURE 3
CHOICE OF COUNTRY (INCLUDING TOTAL TUITION FEES , HOSTEL FEES & FOOD AND MISC. EXPENSES )
CHOOSE 2-3 OPTIONS FROM BELOW AND PUT IT ON ABOVE FORM
1 / KYRGYZ REP. / 12-17 LAKHS ( ) / 10 / CHINA / 22-30 LAKHS ( )2 / CHINA / 12-18 LAKHS ( ) / 11 / BELARUS / 25-28 LAKHS ( )
3 / RUSSIA / 14-24 LAKHS ( ) / 12 / NETHERLANDS /ROMANIA / 30-37 LAKHS ( )
4 / KAZAKHSTAN / 16-20 LAKHS ( ) / 13 / NEPAL / 40-55 LAKHS ( )
5 / ARMENIA / 16-24 LAKHS ( ) / 14 / NETHERLANDS+USA / 40-55 LAKHS ( )
6 / UKRAINE / 17-24 LAKHS ( ) / 15 / MAURITIUS / 42-45 LAKHS ( )
7 / PHILLIPINES / 18-26 LAKHS ( ) / 16 / SOUTH AMERICA / 42-55 LAKHS( )
8 / GEORGIA / 20-25 LAKHS ( ) / 17 / POLAND / 60-65 LAKHS( )
9 / BANGLADESH / 20-30 LAKHS ( ) / 18 / SINGAPORE / MALAYSIA / 65-75 LAKHS( )
.