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~ NAME OF DEGREE NAME OF THE AWARDING BODY YEAR OF PASSING AGGREGATE

(WITH COLLEGE PERCENTAGE ABBREVIATIONS)

10. DETAILS OF U.G. (PROFESSIONAL)

QUALIFICATIONS :-

9. ACADEMIC QUALIFICATION

8.CATEGORY

7. NATIONALITY

6. CONTACT NO.

(LAND LINE/MOBILE/EMAIL ADDRESS)

5. PERMANENT ADDRESS

4. POST AL ADDRESS

3. DATE OF BIRTH

(As per matric certificate)

1. NAME OF APPLICANT

(in block letters)

2. FATHER'S/HUSBAND'S NAME ~~~~~~~~~~~~~~~~~~----;

Application Form for the post of------------------

r:

CENTRAL COUNCIL OF INDIAN MEDICINE NEW DELHI /

Self-attested documents of qualification and experience should be attached alongwith two passport size colour photos ..

Signature of Applicant

I declare that the statements made in this Application are true to the best of my knowledge and belief. If any, information given by me is proved to be false at a later date, my appointment shall be liable to be terminated without notice/compensation. I shall also provide all the necessary documents in original as and when asked for by the Council. Dated: -------

NAME OF POST PAY SCALE NATURE OF DUTIES DETAILS

OF DURATION WITH J)ATE, MONTH AND

YEAR .____

13. DETAILS OF EXPERIENCE IN CHRONOLOGICAL ORDER-

12. OTHER QUALIFICATION, IF ANY

NAME OF NAME OF THE AWARDING YEAR OF NAME OF THE AGGREGATE COURSE COLLEGE BODY PASSING SUBJECT PERCENTAGE

11. DETAILS OF P.G. (PROFESSIONAL)QUALIFICATIONS :-