The application form for grant of Direct Permanent Commission / Short Service Commission in the Army Dental Corps
(USE BLOCK CAPITAL LETTERS ONLY)
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1. Name in full: ........
(as per matriculation certificate)
Name in Hindi: ........
2. Date of birth: ........
3. Age as on December 31, 2004: ........years ........ months ........ days
4. (a) Father's name: ........
(b) Details of spouse (i) (Name): ........
(ii) Nationality: ........
5. Postal address
with pin code: ........
Phone no with STD code: ........
6. Permanent address with pin code: ........
7. Name of college and university from which BDS (MDS) was passed: ........
8. (a) Date of passing BDS (and MDS): ........
(b) Number of attempts taken in final BDS: ........
9. Marks and percentage obtained in final BDS: ........
10. (a) Is the college from which you passed BDS recognised by the DCI?: ........
(b) Is the college from which you completed internship of one year recognised by the DCI? : ........
11.Date of completion of internship: ........
12. Permanent Dental Registration Number, issuing office, valid up to: ........
13. Particulars of present employment: ........
14.Type of commission applied for -- DPC / SSC/ Both*: ........
15.Have you appeared earlier for commission in the Army Dental Corps? If yes, give details: ........
I hereby declare that all the statements made in the application are true and correct to the best of my knowledge and belief.
Date: ........ Signature of the candidate
Important
1. Copies of the following should be enclosed:
(a) BDS (MDS) degree
(b) Matriculation certificate (date of birth certificate)
(c) Dental Registration Certificate duly renewed up to December 31, 2004
(d) BDS final mark-sheet
(e) Internship certificate
(f) Two additional attested, passport sized photographs
(g) Any other relevant documents.
2. Enclose one self-addressed post card and one self-addressed envelope of size 23 cms x 10 cms affixed with Rs 22 worth of stamps for reply by registered Post.
Note: * Strike out whichever is not applicable.
Candidates applying for both must submit separate applications for DPC and SSC.
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