CCIM | Ayush
BUMS Application form
1.Upload Image:
2.First Name of the applicant:
3. Mother's Name of the applicant:
4.Surname or Father's Name of the applicant:
5.Last Name of the applicant:
6.Gender of the applicant:
Male Female
7. Date of Birth of the applicant:
8.Citizenship of the applicant:
9. State of Permanent Residence of the applicant:
10.Permanent Address of the applicant:
11. Present Address (Address of Communication)
of the applicant:

12.The applicant's Community:
13.Seeking Admission in ----------- Category:
14.Contact Telephone Number of the applicant, mother/father/guardian:

a) STD Code - Telephone Number
(b) Mobile Number
15.Course undergone by the applicant at Plus Two, HSE or equivalent:
16. Name and Address of the Educational Institution (Qualifying Examination - HSE or equivalent) last attended by the applicant:

17.Marks obtained by the applicant at National Eligibility Cum Entrance Test (UG-2023),
Central Board of Secondary Education,from the total of 720 marks:
18.Percentage of marks obtained by the applicant at Qualifying Examination (HSE or equivalent):
(Numerical only- Rounding off to the nearest numeral)
19.Has the applicant studied physics,chemistry
and biology in higher secondary/ equivalent to it:
Yes No
20.Percentage of marks obtained at Qualifying Examination (higher secondary/equivalent) in Biology,Physics and Chemistry by the applicant: (Numerical only- Rounding off to the nearest numeral)
21.Course undergone at Secondary Level by the applicant:
22.Percentage of marks obtained at SSLC (or equivalent) by the applicant:
(Numerical only- Rounding off to the nearest numeral)
23.Quota applying for:
24.Upload Signature:
The details provided in the application are true to the best of my knowledge