(IOMIT's) SIR SEEWOOSAGUR RAMGOOLAM MEDICAL COLLEGE BELLE RIVE, MAURITIUS APPLICATION FORM FOR MBBS/MD/MS COURSES 2026-2027    000510/17432 SIGN OF ISSUING AUTHORITY 1. ROLL NUMBER :- (NOT TO BE FILLED BY CANDIDATE) UPLOAD PHOTO :- 2. NAME OF THE APPLICANT :- 3. FATHER'S/GUARDIAN'S NAME :- 4. FATHER'S OCCUPATION :- 5. MOTHER'S OCCUPATION :- 6. ADDRESS FOR CORRESPONDENCE :- STATE :- PIN :- PHONE:- FAX :- EMAIL:- 7. NATIONALITY:- 8. PASSPORT NO:- EXPIRY DATE :- 9. DATE OF BIRTH:- SEX MALEFEMALE 10. FEE PAYMENT PLAN OPTION:- 1. YEARLY2. ONE TIME 11.CENTER OF PREFERENCE:- --Select Center-- DELHI DURBAN KAULA LUMPUR MAURITIUS SHARJAH OTHERS 12.COURSE:- --COURSE-- MBBS MD/MS SUBJECT/SPECIALITIES 13. ADMISSION OPTION:- 1. AUGUST26    2. FEBRUARY27 14.SUBJECT WISE MARKS/GRADE IN THE CLASS 12TH /A LEVEL /MBBS EXAMINATION % OBTAINED MARKS/GRADE   TOTAL MARKS BIOLOGY :-       PHYSICS :-       MATHS :-       CHEMISTRY :-       ENGLISH :-       15. TOTAL MARKS OBTAINED AT MBBS/EQUIVALENT:- 16.DETAILS OF THE NEET/MBBS RESULT NEET MARKS: WHETHER NEET PASS: YES NO WHETHER NEET/MBBS RESULT ATTACHED: YES NO N/A 17. DETAILS OF THE QUALIFYING EXAMINATIONS CLASS 12TH/A LEVEL MATRICULATION - MBBS OR EQUIVALENT: EXAMINATION SCHOOL /COLLEGE UNIVERSITY /BOARD YEAR OF PASSING & ATTEMPT COUNTRY XIIth LEVEL/A LEVEL MBBS/ Equivalent 18. LANGUAGES KNOWN:    ENGLISH FRENCH HINDI OTHER I9. WHETHER HOSTEL IS REQUIRED:   -- Please -- Yes No DECLARATION/UNDERTAKING 1. I have verified all information about this college and the course independently through my own sources without any cajoling, convincing & counseling from the college authorities or any of its officials & staff. I wish to apply for admission to the IOMIT's SSR Medical College, Mauritius and hereby declare that the above information is true and complete to the best of my knowledge, I am aware that if any information herein is found to be incorrect or in complete, my application will be rejected & admission will be cancelled. I undertake that information given by me in this Application Form is not confidential and the College is authorized to use it 'as its own right'. 2. If admitted to SSR Medical College, I shall abide by its rules and regulations. 3. I have read and understood all the provisions contained in the prospectus and hereby agree to abide by these provisions. 4. I, the parent/guardian of the applicant hereby declare that I am aware of the financial obligations of admitting my son/daughter/ward to SSR Medical College. I agree to pay the tution and other fees payable to the institution as fixed by the IOMIT from time to time. I also affirm and endorse the declaration made above by my son/daughter/ward. 5. If and when I become a doctor and start practicing medicine; I will revere the ideals of Param Pujya Aswani Kumars, Maharshi Dhanwantri, Sushrut and Charak and will imbibe and abide by the Hippocratic Oath to the best of my effort and ability. 6. I agree that registration of this application or payment of "Registration Fee" does not confer any right on me in respect of selection for admission, which is solely left to the discretion of the institution. I also understand, undertake and agree that Registration Fee/any other fee is "Non-Refundable." DATE:- PAYABLE AT MAURITIUS IN THE NAME OF "INDIAN OCEAN MEDICAL INSTITUTE TRUST, Security Code:*