KLE Dental College Bangalore- KLE Society's Institute of Dental Sciences


	# 20, Yeshwanthpur Suburb, II Stage, Tumkur Road, Bangalore - 560 022 Tel: +91 80 23474137 Fax: +91 80 23474305
	Affiliated to Rajiv Gandhi University of Health Sciences, Bangalore, Approved by Government of Karnataka and Government of India

Dr. Prabhakar B. Kore

M.P. (Rajya Sabha)

Chancellor, KLE University, Belgaum

Chairman, K.L.E.Society, Belgaum

Accreditions

Course Intending to apply	:	M.D.S B.D.S Selecting any one or all. The exam is common for all

Candidate Details

Candidate's Name (As given in class SSLC/10th Certificate)	:
Father's Name	:
Mother's Name	:
Gender	:	Male Female
Date Of Birth	:	[eg: DD/MM/YYYY]
Address for Communication	:

City	:
Pin	:
District	:
State	:
Email	:
STD Code	:
Telephone	:
Mobile	:

Educational Details

Year of Passing SSLC / SSC / 10th

Percentage in SSLC / SSC / 10th

Please enter Percentage of Marks

Appearing for PUCII / HSC / 12th

Yes No
If appearing this year, Select YES. Already appeared select NO.

Year of Passing PUC II / HSSC / 12th

If appearing this year, Please put 2012.

Name of the PUCII / HSC / 12th Board

Declaration - I


	I hereby declare that the above information is true and complete to the best of my knowledge. I am aware that if any information herein is found to be incorrect or incomplete, my application form will be rejected / admission will be cancelled.
	If admitted to the college of KLE Institute of Dental Sciences, Bangalore, I shall abide by its Rules & Regulations.
	I have read and understood all the provisions contained in the brochure / website and hereby agree to abide by these provisions.
	I will not indulge in any kind of ragging activities.

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