BLDE UNIVERSITY
(Notification No. F.9-37/2007-U.3 (A) Dtd. 29-2-2008 of the MHRD, Govt of India u/s 3 of the UGC Act,1956)
Shri. B. M. Patil Medical College, Hospital and Research Centre,
Smt. Bangaramma Sajjan Campus, Solapur Road, Bijapur - 586103, Karnataka,
Phone No.: 08352-262770, Email: office@bldeuniversity.org, Fax: 263303, Website: www.bldeuniversity.org

BLDEU - UGET - 2013 APPLICATION FORM
Application No.

Candidate's Name :
Father's/Mother Name :
Date of Birth : Paste Your Recent Colour
Photograph as per the
instructions in the brochure.
Gender :
Address :
City : Pin :
State :
Mobile Number-1 & 2 :  

Signature of the Candidate
Email :
Choice of Centre : Cat :
Demand Draft Details : Bank :
D.D. No : D.D. Amount : D.D. Date :
Declaration - I
  1. I 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 incomplete, my application form will be rejected / admission will be cancelled.
  2. If admitted to the college of BLDE University, Bijapur I shall abide by its Rules & Regulations.
  3. I have read and understood all the provisions contained in the brochure and hereby agree to abide by these provisions.
  4. The disputes arising out of the process of the admission through BLDEU-UGET-2013 are subject to the jurisdiction of civil courts of Bijapur.




Left Thump Impression of the Candidate




Signature of the Candidate
Declaration - II
I, the parent / guardian of the applicant hereby declare that I am aware of the financial obligation of admitting my child / ward to the college of the BLDE University, Bijapur. I agree to pay the tuition and other fees payable to the institution as fixed from time to time as per the rules. I also affirm and endorse the declaration made above by my child / ward.
Place :
Date :

Signature of the Parent / Guardian

Authentication by the college where the candidate has last studied or by Gazetted officer.

Mr./ Miss. ............................................................................................................... born on ............................. was a bonafide student of this institute / is known to me since last .................. years and has passed his / her HSC examination held in Month.............Year .........



Signature and Seal of the Head of the Institution / Gazetted Officer