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Application Form

P. D. Hinduja Hospital and Medical Research Centre

Veer Savarkar Marg, Mahim, Mumbai-400 016 India.
Tel: 24449199 / 24452222 / 24451515.

Application Form for Full Time / Part Time Allied Health Sciences Program

(Form to be filled by Applicant in CAPITAL letters)
Course Type : Full Time (FT) / Part Time (PT) (for working applicants with relevant exp.)


Please enter your Middle Name
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Address for communication:

Permanent Address:

Details of Parents/Guardian

Father

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Please enter your Annual Income

Mother/Guardian

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Upload Documents

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Documents size should not more than 2mb.
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Educational Qualification Details

In case your Graduation results have GPA, Sem 1 & 2 GPA has to be mentioned in 1st Year; Sem 3 & 4 for 2nd year and Sem 5 & 6 for 3rd year. Maximum GPA will be taken as 10. Please mention GRADE in case of GPA.
Degree / Certificate Subjects studied Month &year of passing College / University / Board Name Marks Obtained Max Marks Overall %
Others
B.Sc 3rd year
B.Sc 2nd year
B.Sc 1st year
Class XIIth
Class Xth

Work Experience Details

Organisation Name Designation From(dd/mm/yyyy) To(dd/mm/yyyy) Job Role

Admission Procedure

A XEROX OF ALL THE BELOW MENTIONED DOCUMENTS TO BE SUBMITTED AT THE TIME OF FORM SUBMISSION

3 passport size photographs Experience Certificate if any Aadhar card
Xth onwards all certificates and mark sheets (attested) Cancelled cheque of your bank account Pan Card/Voter Id
(For Office Use) Document collected by Verified by

FEES STRUCTURE: Fees can be paid in three instalments.Payment Details(DD/Cheque no)

TOTAL FEES* (non refundable)

₹ 200 at the time of form submission

6 months Course - ₹ 45000+ GST

One year courses - ₹ 55000+ GST

Two year Courses - ₹ 78000+ GST

1st instalment : (at the time of admission + Post-dated cheques for 2nd and 3rd instalments)

On admission

6 months Course - ₹ 25000+ GST

One year courses - ₹ 25000+ GST

Two year Courses - ₹ 40000+ GST

2nd instalment :

At the end of Ist month

6 months Course - ₹ 20000+ GST

One year courses - ₹ 15000+ GST

Two year Courses - ₹ 20000+ GST

3rd instalment :

At the end of 2nd month

One year courses - ₹ 15000+ GST

Two year Courses - ₹ 18000+ GST

Cheque / DD dishonoured by the bank will be charged at 500/- per presentation, No candidate will be eligible to attend the course or the examination on non-payment of fees

*Fees & instalments paid will be non-refundable

I declare that the particulars given by me in this Application are correct. If any of the particulars given or documents submitted by me are not correct or false, my provisional admission will stand automatically cancelled without any intimation, notice or refund to me and I shall also be liable for any other punishment, penalty or legal action in such cases, I have clearly read and understood the fee structure and rules and regulations for the course given in the course brochure.

I fully understand that P. D. Hinduja Hospital & Medical Research Centre (HNH) is affiliated to Maharashtra State Board of Skill Development (MSBSDE) for listed courses. HNH has Life Supporters Institute of Health Sciences (LIHS) as its administrative agency for running Allied Health Courses.

However, I also understand that P. D. Hinduja National Hospital & Medical Research Centre (HNH) and LIHS are not affiliated to any University, University Grants Commission, MCI, NCI or AICTE & this course is not recognized by any statutory agency. The course completion certificate shall be issued by HNH, LIHS & MSBSDE* on successful completion of all the requirements of the course and at sole discretion of HNH, LIHS & MSBSDE*.