NO N O RT R TH H E E AS A ST T ME M ED DI I CA C AL L C CO OL LL L EG E GE E DE D EN NT TA AL L U UN NI I T T
SOUTH SURMA, SYLHET, BANGLADESH
Phone : 02996635188, Ext-306, Fax: 02996636384, Mobile : 01735-603075 E-mail: nemcdental@gmail.com, nemc1998@gmail.com,info@nemc.edu.bd
Web: www.nemc.edu.bd
Application form for Admission in BDS Course Session: 2021-2022
Particulars of Admission Test
Roll No Merit Score Test Score Merit Position
1. Name of candidate (In Capital Letters) : ...
2. Father’s Name : ...
3. Mother’s Name : ...
4. Sex : ...
5. Date of birth (Day/Month/Year) : ...
6. Nationality : ...
7. Address :
a) Present Address : ...
...
b) Permanent Address : ...
...
8. Guardian’s Name and Address (With Telephone / Mobile) : ...
...
9. Guardians Occupation and Annual Income : ...
...
10. Name & Address of person to be notified in case of emergency (With Telephone / Mobile) :
...
...
11. Who will finance during study : ...
12. Knowledge of Language : Your Mother Tongue ...
Knowledge of English ...
Photo
13. Educational Qualification:
Examination Institute Board Year of
passing GPA
(without additional
Subject)
Total
GPA GP in
Biology SSC/O Level
HSC/ A Level
14. Subject :
SSC/O Level
1... 2... 3...
4... 5... 6...
7...
10………
8... 9...
HSC/ A Level
1... 2... 3...
4...
7………
5... 6...
15. Extra curricular activity if any : ...
Signature of father/Guardian Signature of Applicant
Date : Date :
Following must be attached with the application, failing which the application will not be entertained.
1. Copy of Admit card of BDS Admission test.
2. Student copy of online application of BDS admission test.
3. Copy of result of BDS Admission test.
4. Photocopy of certificates and Academic Transcript for SSC/ “O” Lavel and HSC/“A” Lavel.
5. Photocopy of Testimonials from School and College.
6. Nationality Certificate from Mayor / Chairman of City Corporation / Pourashova/ Union Parishad.
7. Recent Photograph 5 copies passport size & 2 copies stamp size photographs.
8. ‘O’ & ‘A’ level equivalence certificate from DGHS.
9. Copy of Pay order /DD of Taka 1000/=.
