Proforma Minority Community Quota Cdc
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Proforma Minority Community Quota Cdc
Transcript of Proforma Minority Community Quota Cdc
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KEAM 2014 Roll No:
KEAM: 2014 ADMISSION TO MBBS/BDS COURSES 2014
COMMUNITY CERTIFICATE FOR CLAIMING RESERVATION
UNDER COMMUNITY QUOTA IN PRIVATE SELF-FINANCING MEDICAL/DENTAL COLLEGES
(GO(Rt)No.2665/2014/H&FWD Dated 05.08.2014)
Certified that, Sri/Smt/Kum..
Son/Daughter of Sri/Smt...
House ... Village ...
Taluk . District ...
of Kerala State belongs to . Caste, ...Religion.
Certified that he/she belongs to . District of
Kerala State.
Place : Signature of Village Officer :
Date : Name :
Designation & Address :
(Office Seal)
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KEAM : 2014
ADMISSION TO MBBS/BDS COURSES 2014 UNDER COMMUNITY QUOTA
IN PRIVATE SELF-FINANCING MEDICAL/DENTAL COLLEGES (GO(Rt)No.2665/2014/H&FWD Dated 05.08.2014)
(To be filled by the candidate and sent to the Office of the Commissioner for Entrance Examinations along
with the Community Certificate from the Village Officer/Revenue Authorities) PROFORMA FOR SUBMISSION OF CANDIDATE DETAILS
Name of Candidate and Address
:
Roll No. of KEAM 2014 :
Kerala Medical Rank 2014 :
Community under which allotment/admission is sought
:
Details of certificates attached :
Place:
Date: Signature of candidate
Note:- For claiming Community quota, attach Community Certificate obtained
from Revenue Officials.
(For office use only)
Remarks: Initials:
