1. Healthcare

SAI SIDDHA ACADEMY (SSA)
REG.No:
TNPSC - AMO (SIDDHA) & M.D(SIDDHA) ENTRANCE
COACHING CENTRE - ENROLLMENT FORM
1. Name (In Capital letter)
:
2. Age & Date of Birth
:
3. Sex
: Male / Female
4. Year of Passing
(BSMS)
Self Attested recent
passport size
photograph to be
affixed in the space
:
M.D(s) :
5. Name of the college - UG :
PG :
6. Permanent Address
7. Mobile No
8. E-mail. ID
9. Batch willingness
10. Father Name & cell no
:
1:
2:
:
: Monthly/ Weekly/ Regular
:
CONSENT BY THE CANDIDATE
1. I will not take a Xerox copy of SSA Question paper.
2. My name and photograph may be used for the advertisement of
SSA in the future.
3. I know that the fees paid by me are not refundable in any circumstances.
I hereby accept the rules and regulation of the SAI SIDDHA ACADEMY.
Date :
Place:
Signature of the candidate.