P.G. Diploma in Proctology

Name(Required)

First Last

Father's/Husband's(Required)

First Last

Address for Communication(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Phone(Required)

Category(Required)

Educational Qualification(Required)

University/Board

Institute

Passing Year

Percentage/CGPA

Proof of Birth(Required)

Drop files here or

Accepted file types: jpg, jpg, pdf, png, Max. file size: 5 MB, Max. files: 1.

10th Certificate can be uploaded

Proof of Identity(Required)

Drop files here or

Accepted file types: jpg, jpg, pdf, png, Max. file size: 5 MB, Max. files: 1.

Aadhaar/Passport/Driving License

Date of Birth(Required)

Nationality(Required)

Gender(Required)

Male

Female

Qualification Certificates(Required)

Drop files here or

Accepted file types: jpg, jpg, pdf, png, Max. file size: 5 MB, Max. files: 10.

Aadhaar/Passport/Driving License

NOC /Recommendation from the Department/Institution in case of Govt. Service

Declaration

I hereby declare that the information mentioned in this Application is correct and true to the best of my knowledge and belief and I understand that furnishing false/improper information will lead to rejection and cancellation of my candidature and also that I am liable for legal and/or disciplinary action as may be initiated by the National Institute of Ayurveda.

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