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 pm Students of 2026-2027

Application Progress 0% Complete

Application ID: PM1292

Keep this ID for future reference Academic Year -1

📝 Basic Information

Candidate's Full Name (Block Letters)

Gender

Date of Birth Age will be calculated automatically

Age on 31.12.2026

Caste Category

NEET UG Quota

Domicile Status

Date of Admission in MBBS

PWD Status (Physically Challenged)

PwD Certificate No. & Issuing Authority

Religion

Nationality

Physically Challenged

Yes

📞 Contact & Basic Details

Registration Year 20

Category pm

Email ID apabrita36@gmail.com

Aadhar Card Number

Student's Mobile no

Blood Group

Hostel Accommodation Required?

Yes

Whether availing any Scholarship (including Kanyashree)?

Yes

Name of Scholarship, if Yes

🏠 Address Information

Premises No./Village Name/Road Name/Street Name, P.O+P.S

Ward No./ Block

City / Town

District

State

Pincode

Permanent Address

Present Address (Use same format of the Permanent Address)

📋 Copy from Permanent Address

NEET UG-2026 Details

NEET pm Roll No

NEET UG Application No.

NEET All India Rank (UG Medical)

Category Rank

🎓 Candidate's Higher Secondary (Class 12th) Details

Name of 10+2 Board

Year of passing 10+2 Examination

10+2 Roll No.

Marks Obtained In			Total Marks In			Percentage Of Marks
10+2 Physics	10+2 Chemistry	10+2 Biology	10+2 Physics	10+2 Chemistry	10+2 Biology	10+2 Physics	10+2 Chemistry	10+2 Biology

10+2 P+C+B Total (Auto-calculated)			10+2 P+C+B Total Marks			10+2 P+C+B Percentage (Auto-calculated)
10+2 ENG			10+2 ENG			10+2 ENG

👨‍👩‍👧‍👦 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

💼 Banking Details

Bank Name

Account Number

IFS Code

Remarks

📁 Document Upload

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

Upload candidate’s 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 2026-2027

📝 Basic Information

NEET Roll No: -

NEET All India Rank: -

Category Rank: -

Registration Year: -

Candidate Name: -

Date of Birth: -

Gender: -

Age on 31.12.2026: - 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: 02/04/2026 Place: _________________ Signature: _________________