Prathama Blood Centre

Introducing PGDTM Course

Donate money
to Support Us

Donate blood
@ Prathama

application form

General Information

Surname or Family name :
First Name :
Sex :	Male Female
Date of Birth :
Nationality :
Country of residence :
Home Address :
Telephone :
Mobile :
E-mail :
Work address, if any :
Telephone(Work) :
Fax :

Education Qualification :

S.N	Education	Year		Board/University	% of marks
		From	To
1.	X^th Grade
2.	XII^thGrade
3.	MBBS-I
4.	MBBS-II
5.	MBBS-III
6.	Intership

Other relevant training / Education.Current job / Position ?

Details :
Name of Applicant :
Date :
Place :
Upload Document :	Attach another File
	Please provide the following which should be sent together with this application form 1. Completely filled Application form. 2. Copy of your MBBS Degree. 3. Copy of Intership certificate. 4. Copy of registration certificate issued by Medical Council of India (MCI) 5. Copies of experience certificate, if any 6. Passport size photograph To download course broacher and apply online visit us at www.prathama.org For more information contact us at hr@prathama.org The Management reserve the right to change the terms and conditions of the training program as these relate to admission procedure, course fee, duration of program ,rules and regulations applicable to the post graduate training.
	Terms & Conditions: DD of Rs. 1500/- in favour of "Prathama Blood Centre" payable at Ahmedabad. I accept that above all the information provided are true to my knowledge and I assure organization to provide original documents as and when they will require. If any of the details provided above will be false, my candidature for the application will be cancelled and I will not have any right to raise objection for the same.