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Rajmata Smt. Devendra Kumari Singhdeo
Government Medical College Ambikapur,
M.B.B.S. Admission
Surguja C.G.
Application Form 2021-22
Photo
Student Name
Allotment Category
Date of Birth*
Age in 31/12/2021
Father's Name
Mother's Name
Details of Father/Guardian
Father's Occupation Govt Self/ Pvt. Farmer
Designation (for Govt)
Name of office and
place
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Postal Address
|Pin Code
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Pin Code
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Date Father /Parent Sign Student Sign
MBBS Selection Detai
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Roll No.
Allotment Category UR IST sc OBC PH Sani F
Obtained Marks/MM
NEET 2021
Rank Over All Rank Category Rank State rank
10th Passing Details
Passing Year
Board Name
School Name
State
12th Passinq Details
Passing Year
Board Name
School Name
State
Subject Total mark obtained mark Percentage
Physics
Chemistry
Marks obtained in 12th
Biology
English
Qualifying marks 50%for UR,40% for ST/SC/OBC and 45% for P.H
Self Declaration
Date Father /Parent Sign Student Sign
Scrutiny
Incharge Admission
RSDKS GMC Incharge
RSDKS GMC Ambikapur
Ambikapur
Telephone Na. UTT74-297800 Email deanmedicalcollegesurguja@[Link]
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