To
The Principal.
Sarjug Dental Collage & Hospital
Mata R. Devi Dental Hospital & Jogender Memorial Medical Hospital
Hospital Road , Laheriasarai
Darbhanga (Bihar ),
Pin : 846003
Courses Name  
   
First Name Date of Birth Category
Last Name Nationality
Student Mobile No. Email ID
Gender Fathers Name
Religion Father's Occupation
Identification Mark Father Email ID
Mother's Name    
Parent Annual Income    
Guardian Contact (in case Father & Mother are not alive)
Guardian Name Guardian Occupation
Guardian Mobile No Relationship Type
Correspondence Address
State Pin Code
Landline No Mobile No
Street Address    
Permanent Address
State Pin Code
Landline No Mobile No
Street Address    
Local Address (Compulsory for students residing outside Bihar)
   
Qualification
Qualifying Exam Last Exam Passed
Last School/College Last Board/University
Last School/College Reg. No    
School/College Name State City % of Marks Division Pass Year Board
Details of NEET (National Eligibility Cum Enterance Test)
Centre From Where Appear Admit Card/Roll No.
Total Marks Obtained Percentage/Percentile
Year in which NEET Given Result of NEET Exam