# 20, Yeshwanthpur Suburb, II Stage, Tumkur Road, Bangalore - 560 022
Tel: +91 80 23474137 Fax: +91 80 23474305
Affiliated to Rajiv Gandhi University of Health Sciences, Bangalore,
Approved by Government of Karnataka and Government of India
Dr. Prabhakar B. Kore
M.P. (Rajya Sabha)
Chancellor, KLE University, Belgaum
Chairman, K.L.E.Society, Belgaum
Course Intending to apply : M.D.S B.D.S
Selecting any one or all. The exam is common for all
   Candidate Details   
Candidate's Name
(As given in class SSLC/10th Certificate)
Father's Name :
Mother's Name :
Gender : Male Female
Date Of Birth :  
[eg: DD/MM/YYYY] 
Address for Communication :
City :
Pin :
District :
State :
Email :
STD Code :
Telephone :
Mobile :
   Educational Details   
Year of Passing SSLC / SSC / 10th :
Percentage in SSLC / SSC / 10th :
Please enter Percentage of Marks
Appearing for PUCII / HSC / 12th : Yes No
If appearing this year, Select YES. Already appeared select NO.
Year of Passing PUC II / HSSC / 12th :
If appearing this year, Please put 2012.
Name of the PUCII / HSC / 12th Board :
Declaration - I
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.
If admitted to the college of KLE Institute of Dental Sciences, Bangalore, I shall abide by its Rules & Regulations.
I have read and understood all the provisions contained in the brochure / website and hereby agree to abide by these provisions. 
I will not indulge in any kind of ragging activities.
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