Application Form
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Fields marked with*are mandatory.
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Please click here for detailed instructions to fill up the form.
 
Personal Information
*Name of the applicant (As in Qualifying Examination)
(First Name) (Middle Name) (Last Name)
*Date of Birth
*Gender Male Female
*Mother's Name *Category
*Father's Name *State of Domicile
*Guardian Name *Guardian Relationship with the Applicant
*Mobile No. *Email Address
Telephone with Area Code *Confirm Email

Present Address
*Address Line 1
*Country
Address Line 2 *State
*Town/City *District
*Pincode

Permanent Address Same as Present Address? Yes No

Permanent Address
*Address Line 1
*Country
Address Line 2 *State
*Town/City *District
*Pincode



Upload Your Photo
 
  Please upload your photo and signature here.
   
Courses
*Type
Please select course category option
Certificate  Diploma   Under Graduate  Post Graduate  Ph.D. 


Accommodation and transport requirement detail
Note Subject to availability.
*Do you need hostel accommodation?
Yes  No 
*Do you need transport? Yes  No 
   
Qualifying Examination Details
Name of the
Exam.
Name of Board /
University
Year of Passing School / Institute
Name & Add.
Whether Govt./
Pvt. Institute
Marks / CGPA Obtained Maximum Marks / CGPA Percentage of Marks
10th
12th
Diploma
UG
PG
  
* Are the result and details of the qualifying exam available now?
    Yes    No   

  *Qualifying Examination     *Roll Number
  *Total Marks / CGPA Obtained   
  *Total Percentage
  *Board/University
  *Year Of Passing (YYYY)
 
Note Please note that all relevant information and details if applicable to you should be sent to PDM as and when they are available, but before the last date of application.
   
*Payment Procedure
Cash payment at PDM
Cash Payment through Scratch Card
Online Payment (Credit Card / Debit Card)
Application enclosures
Note Please enclose the following documents in original alongwith this form printout at the time of physical counselling.
    1. Rank Card of the relevant Entrance Test(s) as claimed in the application form.
    2. Matriculation / High School Certificate (for Date of Birth)
*3. Qualifying Examination i.e. 10+2 / Diploma / Graduation / Post Graduation or any other examination (for eligibility)
    4. Character Certificate from the Institution last attended (for regular students).
*5. Migration Certificate
*6. Address Proof (Ration Card / Electricity Bill / Telephone Bill, etc.)
    7. SC/BC Certificate ( if Applicable)
*8. 6 Passport size recent colored photos.
    9. Certificate of Medical Fitness in the prescribed Performa.
*10. Affidavits in Prescribed format regarding non indulgence in ragging.
Declaration

   

   
Version 13.03.01