Nil Ratan Sircar Medical College & Hospital (NRSMC&H)

138, A.J.C Bose Road, Kolkata - 700014

Phone number - 033 2286 0033 / 033 2286 0195

Email - principalnrsmc@gmail.com

Application Form for ug Students of 2025-2026

Application Progress 0% Complete

Application ID: UG129121

Keep this ID for future reference Academic Year 21-22

📝 Basic Information

NEET ug Roll No *

All India Rank *

Category Rank *

Candidate's Full Name *

Date of Birth * Age will be calculated automatically

Gender *

Physically Challenged *

Yes

Sub Category *

Age on 31.12.2025 *

🎓 Academic Information

Name of 10+2 Board *

Year of passing 10+2 Examination *

Marks Obtained In	Total Marks In	Percentage Of Marks	Percentile Of Marks
10+2 P+C+B (Physics + Chemistry + Biology) *	10+2 P+C+B (Physics + Chemistry + Biology) *	10+2 P+C+B (Physics + Chemistry + Biology) *
10+2 ENG *	10+2 ENG *	10+2 ENG *
Entrance Exam Name *	NEET SS Percentage *	NEET SS Percentile *	NEET SS Marks Obtained *

📞 Contact & Basic Details

Registration Year * 21

Category * ug

Email ID * a.tarafdarneet@gmail.com

Type *

Blood Group *

Student's Mobile no *

👨‍👩‍👧‍👦 Family Information

Father's Name *

Father's Occupation *

Father's Contact Number

Mother's Name *

Mother's Occupation *

Mother's Contact Number

Guardian's Name, Relationship *

Guardian's Occupation *

Guardian's Contact Number *

Approximate Annual Income Of The Family *

🏠 Address Information

Permanent Address *

Present Address *

📋 Copy from Permanent Address

Block

City *

District *

State *

Pincode *

💼 Additional Information

Hostel Accommodation Required? *

Yes

Whether availing any Scholarship (including Kanyashree)? *

Yes

Name of Scholarship, if Yes

Bank Name *

Account Number *

IFS Code *

Aadhar Card Number *

📁 Document Upload

Upload Image (Max: 1024x1024 pixels, 500KB, JPG/PNG) * Passport-size photo. Accepted: 150x150 to 1024x1024 pixels, up to 500KB

Upload Signature (Max: 600x200 pixels, 500KB, JPG/PNG) * Clear signature. Accepted: 100x50 to 600x200 pixels, up to 500KB

✅ Declaration & Submit

I hereby certify that the above information given are true and correct as to the best of my knowledge.

Note: These particulars cannot be changed till the candidate completes internship. All official communications will be made in these contact details.

📤 Submit Application

N R S MEDICAL COLLEGE & HOSPITAL

APPLICATION FOR ADMISSION TO UG COURSE

Academic Year 2025-2026

📝 Basic Information

NEET Roll No: -

All India Rank: -

Category Rank: -

Registration Year: -

Candidate Name: -

Date of Birth: -

Gender: -

Age on 31.12.2025: - Years

Sub Category: -

Physically Challenged: -

🎓 Academic Information

Board/Examination: - | Year of Passing: -

Subject	Marks Obtained	Total Marks	Percentage

📞 Contact Information

Email ID: -

Mobile No: -

Blood Group: -

Type: -

👨‍👩‍👧‍👦 Family Information

Father's Name:
-

Father's Occupation:
-

Father's Contact:
-

Mother's Name:
-

Mother's Occupation:
-

Mother's Contact:
-

Guardian's Name & Relationship: - | Occupation: - | Contact: -

Annual Family Income: -

🏠 Address Information

Permanent Address:
-

Present Address:
-

City: -

District: -

State: -

Pincode: -

💼 Additional Information

Hostel Required: -

Scholarship: -

Scholarship Name: -

Bank Name: -

Account No: -

IFS Code: -

Aadhar Number: -

📁 Documents

Photograph

Photo will appear here

Signature

Signature will appear here

Declaration

I hereby certify that the above information given are true and correct as to the best of my knowledge. These particulars cannot be changed till the candidate completes internship. All official communications will be made in these contact details.

Date: 09/08/2025 Place: _________________ Signature: _________________