Various Fee Collection Form
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Course/Institute Details
University
*
Madhya Pradesh Medical Science University, Jabalpur
Faculty*
Select Faculty
Ayurvedic
Certificate Course
Dental
Homeopathy
Medical
Nursing
Paramedical
Post Graduate Diploma (Medical)
PostGraduate Diploma (Paramedical)
RCI
Superspeciality Course
Unani
Yoga & Naturopathy
Please select Faculty.
College Name
*
Select College
Please select College/UTD Name.
Course
*
Select
Please select Course Name.
Branch
*
Select Branch
Please select Branch Name.
Year/Semester
*
Select
Please select Year/Semester.
Branch Mode
*
Select
Regular
Please select BranchMode(Regular/Private).
Personal Details
Enrollment Number:
Please Enter enrollment number
Please enter only [a-z,0-9] in Enrollment Number.
Roll Number
*
:
Please enter roll number
Please enter only [a-z,0-9] in Roll Number.
Applicant Name
*
Applicant Name is required!
Date of Birth
*
Format: (DD/MM/YYYY)
Please enter DOB
Please enter only DD/MM/YYYY format in Date of Birth.
Father/Husband Name
*
Father/Husband Name is required!
Mother Name
*
Mother's Name is required!
Gender
*
Select Gender
Female
Male
Transgender
Please select Gender.
Category
*
Select Category
EWS
OBC
SC
ST
UR
Please select Category.
Mobile No.
*
Mobile No. is required!
Email Id
*
Email id is required!
Address
House No/Village
*
House No/ Village Name is required!
Colony/ Post
*
Colony/ Post Name is required!
City/ Tehsil
*
City/ Tehsil Name is required!
District
*
District Name is required!
State
*
Select State
Andaman and Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli
Daman and Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Orissa
Pondicherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
Please select state.
Pincode
*
Pincode is required!
Payment Details
Department
*
Select
Please select Department/Fee Section.
Fee Head
*
Select
Please select Fee Head/type.
Fee
*
₹
Please confirm fees from University before entering
Fee amount is required!
Remarks/Reason:
*
Remarks/Reason is required!
Declaration
1) मैं प्रमाणित करता/करती हूं कि मेरे द्वारा आवेदन पत्र में दी गई उपरोक्त जानकारी सही है। यदि कोई भी जानकारी असत्य पायी जाती हें तो मेरा आवेदन निरस्त कर दिया जाये एवं किसी भी प्रकार की हानि का समस्त उत्तरदायित्व मेरा होगा।
2) मेरे द्वारा फीस जमा करने के पूर्व, उससे सम्बंधित विश्वविद्यालय/कॉलेज से फीस का सत्यापन किया जा चुका हैं यदि जमा किये गएँ शुल्क में किसी भी प्रकार की त्रुटि पाई जाती हैं तो मैं स्वयं जिम्मेदार रहूँगा / रहूगी, एवं समस्त प्रकार के वित्तीय (Financial) नुकसान के लिये स्वयं की जिम्मेदारी होंगी|"
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