Name:______________________________________________________________________
Father's/Husband's Name:______________________________________________________
MCI Registration Number (If required): ____________________________________________
Qualification:________________________________________________________________
Postal Address:______________________________________________________________
___________________________________________________________Pin:_________________
Phone (off) : __________________________Phone(Res) :__________________________________
E-mail : _____________________________Date of Birth :__________________________________
Educational Details

Payment Details

DD No: _____________________ Bank: _______________________________________Date:______________
Amount Rs.:_________________ In Words:______________________________________________________
I hereby declare that the particulars provided in the application form are correct and I have gone through the prospectus before filling the application. I shall be disciplined and adhere to all the rules and regulations of Apollo Hospitals Educational and Research Foundation and Medvarsity Online Ltd.
 
DATE:                                                                                                                               SIGNATURE
___________________________________________________________________________________

Instructions

  • Please fill the application form completely and furnish all details required therein.
  • Please enclose attested copies of relevant certificates along with two stamp size photographs
  • The completed admission form must reach us before the last date for admissions. AHERF or Medvarsity is not responsible for any postal delays.
  • Application for online course to be posted to Medvarsity Online Ltd, Life Sciences Building, Apollo Hospitals, Jubilee Hills, Hyderabad-33 A.P., India
  • All disputes with regard to this course are subject to the jurisdiction of Hyderabad.
  • DD should be made in the name of “Medvarsity Online Ltd.” payable at Hyderabad. Write your name and course name in the back of DD / Cheque.
  • ONLINE PAYMENT CAN BE DONE USING CREDIT CARD. Click on “Payments” in the home page of www.medvarsity.com.
  • Please CLICK HERE to go through the terms & conditions.

For further details contact:
Medvarsity Online Limited
Life Sciences Building, Apollo Hospitals Complex, Jubilee Hills, Hyderabad - 500 033, Tel : 040-23541654 /23554723
E-mail:enquire@medvarsity.com, Website: www.medvarsity.com