Online Application form for Admission to Management seats for MBBS in Co-operative Medical College, Kochi under CAPE for 2009-2010 Name of Candidate (Initials must be at the end)* Date of Birth* Day   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31    Month  Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec    Year  1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000   Sex*   Male Female   Name of Father/Mother/Guardian* Specify Relationship Whether a native of Kerala Yes No Category SC ST SEBC Others Address for communication   House Name/No. * Place* City/District, Post Office* Pin Code*   Permanent address (Same as above    )   House Name/No. *   Place*   City/District, Post Office*   Pin Code*   E-mail id   Contact number     STD Code   Telephone number   Mobile phone number   Qualifying examination passed* HSC CBSE ISC VHSE Others   Specify, if selected Others   Marks secured in the qualifying examination   Subject Maximum marks Marks secured Marks Percentage Biology* Physics* Chemistry * Percentage of Marks obtained in the Entrance examination* : Entrance rank :     Declaration I do hereby affirm that all the particulars furnished above are true to the best of my knowledge and belief and that I shall abide by the rules and regulations for admission to Management seats for MBBS in Co-operative Medical College, Kochi under the Co-operative Academy of Professional Education, CAPE I agree*