Form – KLE Hospital

Student Information

Upload Photo *

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Upload Signature *

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Applied for *

For the year *

College *

Candidate name *

Father's name *

Mother's name *

Date of birth *

Gender *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Academic & Education details

Qualify exam passed *

Month & Year of passing *

Final year % *

Aggregate % *

Completion of Internship (month & year) *

Name of college studied *

Declaration - 1

1. I hereby declare that the above information Is true and complete to the best of my knowledge. I am aware that If any information herein is found to be incorrect or incomplete, my application form will be rejected / admission will be cancelled.
2. If admitted to any of the constitute unit a of KLE Academy of Higher Education & Research, Belagavi. I shall abide by it's Rules and Regulations
3. I have read and Understood all the provisions contained In the brochure and hereby agree to abide by those provisions.
4. l am aware that, any legal matters arising out of the total admission process of any Course through KAHER - 2021-22 will be in the courts of Belagavi

Date *

Place *

Signature of candidate *

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Declaration - 2

I, the parent / guardian of the applicant hereby declare that I am aware constituent units of KLE Academy of Higher Education & Research, Belagavi. I agree to pay the tuition other fees payable to the institution as fixed from time to time as per the rules. I also affirm and endorse the declaration mode above by my child / ward.

Date *

Place *

Signature of parent/guardian *

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