BIO-DATA FORM TO FILL APPLICATION OF jipmer.edu.in WALK-IN Name of the department: 1.
Applicant’s Name (in BLOCK LETTERS):-
Date of Birth of Applicant
Educational/Academic/Technical/Professional Qualifications:Examination Subject Name of College/ Name of Passed Institution University
Year of Passing with % of Marks
No. of papers published:National
Details of prizes, 1. Medals
3. National/ International Awards and additional qualification such as membership of scientific societies etc. 7.
Any other information of meritorious nature.
Date: __________________ Place: __________________
(Signature of the applicant)
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