Government of Bihar

Bihar Combined Entrance Competitive Examination Board

Online Application Form for attending Counselling for admission to first Year Degree Course in Bihar State Medical / Dental /
Ayurvedic / Homoeopathic / Tibbi Colleges for the session 2018 on the basis of NEET(UG)-2018.
The entries below regarding personal details must be same as uploaded in the online submitted application form of NEET(UG)-2018.

UGMAC ID Please don't send this Hard Copy to BCECE Board ALL INDIA NEET RANK
7180005955 48547

PART A
1.NEET(UG)-2018 Reg. No.: 40523863

2.NEET(UG)-2018 Roll No.: 502606839

3. Name of Candidate: AASHISH RANJAN

4. Father’s Name: JITESH PRASAD

5. Date of Birth: 14 / SEPTEMBER / 1999

6.Gender: MALE

7.Reservation Category: EBC (EXTREMELY BACKWARD CASTE)

8.Disabled Quota: NO
9.Mobile No.: 7678517738
10.Email ID: Ranjanaashish018@gmail.com
11.Marks of identification: MOLE ON BACK OF NECK
Note : Please Affix your same photo and put your full signature in
12.Aadhar No.: N/A English and Hindi in spaces provided above.
13.Are You Permanent Resident of Bihar?: YES
14.Residential Eligibility:
15.Districts Name of the Institute of Passing/ Appearing : OTHER
16.Do you claim for Minority Seat in Private Medical/Dental Colleges of Bihar?: NO
17.Type of Minority: N/A
18.Have you passed matriculation with URDU as a subject?: NO

19.Payment Details:
Payment Mode Journal No./ Transaction No. Deposit Date Amount (in Rs.)
ONLINE UGMAC5b30aef21353b 2018-06-25 14:32:36 Rs. One Thousand Two Hundred

20.Address Details:
A. PERMANENT ADDRESS : B. CORRESPONDENCE ADDRESS :
AASHISH RANJAN S\O JITESH PRASAD VILLAGE NEORA AASHISH RANJAN S\O JITESH PRASAD VILLAGE NEORA
NEORA NEORA
BIHTA BIHTA
DISTRICT: PATNA DISTRICT: PATNA
STATE: BIHAR PIN CODE : 801113 STATE : BIHAR PIN CODE : 801113

21.Educational Details:
Level School/ College Name Board/ University Name Passing Status Passing Year
Central Board of Secondary
Secondary / Standard X DAV Jasola Vihar Passed 2015
Education
Central Board of Secondary
I.Sc. /XII (10+2) DAV Jasola Vihar Passed 2017
Education
Subject English Physics Chemistry Biology
Marks Obtained 87 91 95 92
Full Marks 100 100 100 100

Declaration by the Candidates : I AASHISH RANJAN declare that information furnished above are correct and I shall forfeit my candidature
and will be liable for legal action in case of any of them is proved to be false at any stage inclusive of admission or thereafter.
Date : ..........................
Place : .......................... (Signature in English) (Signature in Hindi)

UGMAC ID :7180005955 Printed On: 25-06-2018 14:33:54 Page: 1/1

 Government of Bihar
Bihar Combined Entrance Competitive Examination Board
Online Application Form for attending Counselling for admission to first Year Degree Course in Bihar State Medical / Dental /
Ayurvedic / Homoeopathic / Tibbi Colleges for the session 2018 on the basis of NEET(UG)-2018.
The entries below regarding personal details must be same as uploaded in the online submitted application form of NEET(UG)-2018.

UGMAC ID Please don't send this Hard Copy to BCECE Board ALL INDIA NEET RANK
7180005955 48547

PART B
(For Office use only)

UGMAC ID: 7180005955 NEET(UG)-2018 Reg. No.: 40523863 NEET(UG)-2018 Roll No.: 502606839 Category:EBC

Selected for Admission(First Counselling) Selected for Admission(Second Counselling) Selected for Admission(Third Counselling)

Against NEET(UG)-2018 Roll No. ....................... Against NEET(UG)-2018 Roll No. ....................... Against NEET(UG)-2018 Roll No. .......................
Category ................................................................ Category ................................................................ Category ................................................................
Merit Serial ............................................................ Merit Serial ............................................................ Merit Serial ............................................................
at ........................................................(institution) at ........................................................(institution) at ........................................................(institution)
in ...............................................(Course/ Branch) in ...............................................(Course/ Branch) in ...............................................(Course/ Branch)

Signature of Signature of the Signature of Signature of the Signature of Signature of the

Controller of Controller of Controller of
the Candidate Verifying the Candidate Verifying the Candidate Verifying
Examination Examination Examination
(At the time of Officer (At the time of Officer (At the time of Officer
BCECEB BCECEB BCECEB
Counselling) UGMAC-2018 Counselling) UGMAC-2018 Counselling) UGMAC-2018

Date : ...................... Date : ...................... Date : ......................

PART B
1.NEET(UG)-2018 Reg. No.: 40523863

2.NEET(UG)-2018 Roll No.: 502606839

3. Name of Candidate: AASHISH RANJAN

4. Father’s Name: JITESH PRASAD

5. Date of Birth: 14 / SEPTEMBER / 1999

6.Gender: MALE

7.Reservation Category: EBC (EXTREMELY BACKWARD CASTE)

8.Disabled Quota: NO
9.Mobile No.: 7678517738
10.Email ID: Ranjanaashish018@gmail.com
11.Marks of identification: MOLE ON BACK OF NECK
Note : Please Affix your same photo and put your full signature in
12.Aadhar No.: N/A English and Hindi in spaces provided above.
13.Are You Permanent Resident of Bihar?: YES
14.Residential Eligibility:
15.Districts Name of the Institute of Passing/ Appearing : OTHER
16.Do you claim for Minority Seat in Private Medical/Dental Colleges of Bihar?: NO
17.Type of Minority: N/A
18.Have you passed matriculation with URDU as a subject?: NO

19.Payment Details:
Payment Mode Journal No./ Transaction No. Deposit Date Amount (in Rs.)
ONLINE UGMAC5b30aef21353b 2018-06-25 14:32:36 Rs. One Thousand Two Hundred

UGMAC ID :7180005955 Printed On: 25-06-2018 14:33:54 Page: 1/4

 20.Address Details:
A. PERMANENT ADDRESS : B. CORRESPONDENCE ADDRESS :
AASHISH RANJAN S\O JITESH PRASAD VILLAGE NEORA AASHISH RANJAN S\O JITESH PRASAD VILLAGE NEORA
NEORA NEORA
BIHTA BIHTA
DISTRICT: PATNA DISTRICT: PATNA
STATE: BIHAR PIN CODE : 801113 STATE : BIHAR PIN CODE : 801113

21.Educational Details:
Level School/ College Name Board/ University Name Passing Status Passing Year
Central Board of Secondary
Secondary / Standard X DAV Jasola Vihar Passed 2015
Education
Central Board of Secondary
I.Sc. /XII (10+2) DAV Jasola Vihar Passed 2017
Education
Subject English Physics Chemistry Biology
Marks Obtained 87 91 95 92
Full Marks 100 100 100 100

22. Declaration by the Candidates :

I AASHISH RANJAN Son/Daughter of JITESH PRASAD hereby solemnly and sincerely affirm the statements made and information
furnished above by me and in the enclosures hereby submitted by me are true and correct. I have not kept my information secret. If, however, it is
found that any information furnished therein is fraudulent, incorrect or untrue in materials/particulars, I realize that I am liable to criminal
prosecution and agree to forego my seat in the college and further that the selection and admission to this course is liable to be cancelled. I agree
to abide by the rules and regulations governing this counselling.
Repeat bellow in your handwriting (not in capital letters) the above mentioned Declaration and put your signature in English and Hindi at the
specified spaces as signed in Part A of the Online Application forms. If you fail to do so, your Candidature shall be rejected.

Place : .......................... Full Signature in Hindi....................................................................................

Date : .......................... Full Signature in English.................................................................................

Counter signature of the Father/Mother/Guardian

23.List of Enclosure:

1. ................................................................................................ 2. ................................................................................................

3. ................................................................................................ 4. ................................................................................................

5. ................................................................................................ 6. ................................................................................................

7. ................................................................................................ 8. ................................................................................................

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 24. (AT THE TIME OF FIRST COUNSELLING/ INTERVIEW ONLY)

(i). Full Signature of the Candidate (English)......................................... (ii). L.T.I of the Candidate

(Hindi)............................................

(AT THE TIME OF SECOND COUNSELLING/ INTERVIEW ONLY)

(i). Full Signature of the Candidate (English)......................................... (ii). L.T.I of the Candidate

(Hindi)............................................

(AT THE TIME OF THIRD COUNSELLING/ INTERVIEW ONLY)

(i). Full Signature of the Candidate (English)......................................... (ii). L.T.I of the Candidate

(Hindi)............................................

25.
(FOR OFFICE USE OF THE CONCERNED INSTITUTE ON THE BASIS OF FIRST COUNSELLING)

Admit............................................Category............................................Merit Sl. No. of SQR.................................................of UGMAC-2018 and

AIR........................................of NEET(UG)-2018 in the First Year.......................................Branch/ Course of this Institute as He/ She fulfilled all
the requirements of being admitted.

SIGNATURE OF THE
SEAL OF THE INSTITUTE
DIRECTOR/PRINCIPAL
(FOR OFFICE USE OF THE CONCERNED INSTITUTE ON THE BASIS OF SECOND COUNSELLING)

Admit............................................Category............................................Merit Sl. No. of SQR.................................................of UGMAC-2018 and

AIR........................................of NEET(UG)-2018 in the First Year.......................................Branch/ Course of this Institute as He/ She fulfilled all
the requirements of being admitted.

SIGNATURE OF THE
SEAL OF THE INSTITUTE
DIRECTOR/PRINCIPAL
(FOR OFFICE USE OF THE CONCERNED INSTITUTE ON THE BASIS OF THIRD COUNSELLING)

Admit............................................Category............................................Merit Sl. No. of SQR.................................................of UGMAC-2018 and

AIR........................................of NEET(UG)-2018 in the First Year.......................................Branch/ Course of this Institute as He/ She fulfilled all
the requirements of being admitted.

SIGNATURE OF THE
SEAL OF THE INSTITUTE
DIRECTOR/PRINCIPAL

UGMAC ID :7180005955 Printed On: 25-06-2018 14:33:54 Page: 3/4

 Government of Bihar
Online Application Form for attending Counselling for admission to first Year Degree Course in Bihar State Medical / Dental
/ Ayurvedic / Homoeopathic / Tibbi Colleges for the session 2018 on the basis of NEET(UG)-2018.

UGMAC ID Please don't send this Hard Copy to BCECE Board ALL INDIA NEET RANK
7180005955 48547

UGMAC ID:7180005955 NEET(UG)-2018 Reg. No.:40523863 NEET(UG)-2018 Roll No.:502606839 Category:EBC

26. Your Preference/ Choice .

Sl. No. College

1. PATNA MEDICAL COLLEGE, PATNA

2. NALANDA MEDICAL COLLEGE, PATNA

3. I.G.I.M.S. COLLEGE, PATNA

4. DARBHANGA MEDICAL COLLEGE, LAHERIASARAI

5. ANUGRAH NARAYAN MEDICAL COLLEGE, GAYA

6. JAWAHAR LAL NEHRU MEDICAL COLLEGE, BHAGALPUR

7. S.K.MEDICAL COLLEGE, MUZAFFARPUR

8. GOVERNMENT MEDICAL COLLEGE, BETTIAH

9. VARDHMAN INSTITUTE OF MEDICAL SCIENCE AND RESEARCH, PAWAPURI, NALANDA

10. KATIHAR MEDICAL COLLEGE, KATIHAR

11. MATA GUJARI MEMORIAL MEDICAL COLLEGE, KISHANGANJ

12. NARAYAN MEDICAL COLLEGE & HOSPITAL, SASARAM

13. PATNA DENTAL COLLEGE, PATNA

14. BUDDHA INSTITUTE OF DENTAL SCIENCE AND HOSPITAL, KANKARBAGH, PATNA

15. MITHILA MINORITY DENTAL COLLEGE AND HOSPITAL, DARBHANGA

16. SARJUG DENTAL COLLEGE AND HOSPITAL, LAHERIASARAI, DARBHANGA

17. DR. B.R. AMBEDKAR INSTITUTE OF DENTAL SCIENCE & HOSPITAL, BAILEY ROAD, PATNA

18. RAJKIYA AYURVEDIC COLLEGE, PATNA

19. RAJKIYA HOMOEOPATHIC COLLEGE, MUZAFFARPUR

20. GOVT. TIBBI COLLEGE, PATNA

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