TIMP
TAGORE INSTITUTE OF MEDICAL SCIENCE & RESEARCH CENTER
Application Form
30/B, L.B. Road, Thiruvanmaiyur, CHENNAI -45
43, G.S.T Road, M.R. Theatre Complex, Tambaram, Chennai - 600 045, TamilNadu, India
Telephone: 044-64555006 Mobile: 9381384866 ,9381384844.
E- mail : tims.tambaram@gmail.com
 
Application Id :
Name of the Applicant :
Course applied for :
Amount :
Gender :
Place Of Birth :
Date Of Birth :
E-mail ID :
Mobile Number :
Correspondence Address in full
(to which reply to this application may be send)
:
Father Name(Guardian's Name & Relationship)Occupation, his/her permanent Address & Contact Number :
Name & Address Of the Parent/Guardian Occupation of the Parent/Guardian. :
Languages Which the Candidate can Speak/Write/Read :
Reference (Name / Mobile No. Need to Enter) :
Details of Educational Qualification :  
Year Examination Passed Board / University Division % of Marks
 
Whether admission is for day or evening college or weekend :
Work Expriences :
Payment Mode :
Payment Status : Waiting
Register Date :
Hostel Facility Required :
     
     
DECLARATION BY THE APPLICANT

I hereby declare that information furnished is true & correct. I will abide by rules & regulation of the institute given below

1.Foreign students should submit Xerox copy of the passport & visa
2. All the fees becomes payable within 7 days from the date of receipt of intimation of admission
3. Fees once paid will in no case be refunded whether the candidate is unable to join or pursue the course
4. Student should be punctual and regular in attendance
5. Misconduct: student found wanting in punctuality , attendance and conduct are liable for removal from the institute
6. Medium of instruction: student will be taught in English, explanation will also be given in Tamil.
7. punctuality & attendance 75% attendance is compulsory to write the examination
8. Right to suspend: right to suspend/expel/ debar a student, vest with management to maintain good name of the institute.
9.The use of mobile/ cell phone is strictly prohibited in the class room.
 
Office Use Only
Station   Signature of Applicant
     

Date

  Signature of Candidate
     
Principal   MD