[ Please fill in the application form completely in block letters ]

Name:______________________________________________________________________
Father's/Husband's Name:______________________________________________________
Postal Address:______________________________________________________________
___________________________________________________________________________
______________________________________________________Pin:_________________
Telephone : __________________________Mobile :__________________________________
E-mail : _____________________________Date of Birth :__________________________________
Educational Details
  
     Payment Details
Amount Rs.:_________________ In Words:______________________________________________________
DD No: _____________________ Bank: _______________________________________Date:______________
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 the 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, AP, 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.

. ONLINE PAYMENT CAN BE DONE USING CREDIT CARD. Click on "Payments" in the home page of www.medvarsity.com

For further details contact
Medvarsity Online Limited

Life Sciences Building, Apollo Hospitals C omplex, Jubilee Hills, Hyderabad - 500 003. Tel: 040-23541654 / 23554723.
Email: medvarsityinfo@gmail.com, enquire@medvarsity.com, Website: www.medvarsity.com