(*) Fields are Mandatory.


Name Of Degree Passing Year Final Year Total Marks Final Year Obtained Marks Percentage No of Attempt(in numbers only)
*Name of Medical College
*Name of University
*Gujarat Medical Council Registration Number (ex. 'G' or any Letter only) (enter only numeric part only) *Date
*Period of Internship *From Date *To Date
Additional Qualification
Sr No. District Taluka Center Type Center
1
2
3