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Diploma Course in Varma - Duration : 3 - 12 Months

Application Form

Course Selection
	Diploma in VARMA & MEDICAL SCIENCE (DVMS) (Varma, Ayurvedha, Panchakarma, Acupuncture, Yoga, Naturopathy & Herbal Science)
	P.G.Diploma in VARMA & MEDICAL SCIENCE (PGDVMS) (Varma Treatment methods for Chronic Disease (Arthritis, Musculoskeletal pain, Disc Prolapse, Chronic heart disease, Ulcer, Kidney disease, Hypertension, Immune deficiency syndrome, Skin diseases, Psychiatric disorders, Weight Loss, Infertility etc.,)
Medium	Tamil	English

NAME (In Capitals):

D.O.B: (Year)

Age:

Sex: Male Female

Marital Status: Married Single

Nationality:

Religion:

Address I: Father/ Guardian Name & Permanent Address

Address II: Address to which the communication is to be sent

Phone / Mobile No:

Email ID:

Academic Qualification:

Details of Qualifying Examination Passed:

Name of the Course	Subject/Major	Institution / University	Year of Passing	% of marks	Grade / Class
SSLC
H.Sc., / PUC
UG
PG
Diploma

Occupation:

Special Skill:

Hobbies:

Enclosures:

Proof of date of birth	Passport size photograph (2Nos.)
Attested Copies of Degree / Diploma Certificate and Statement of Marks
Service Certificate of Candidate	Demand Draft / Cheque (Original)

Note: Check In all the Enclosures.

Payment Details	DVMS: Rs. 15,000/- + Rs. 30,000/-		PGDVMS: Rs. 15,000/- + Rs. 60,000/-
Name of the Bank:		Branch:
Cheque / Demand Draft No.		Date:
Amount Paid: Rs		(Rupees	)

DECLARATION

I hereby declare that the particulars given above are correct. If any particulars given are found to be incorrect at any point of time, I will abide by the decisions of the Institution. I will, if admitted, abide by the rules and regulations of the Institution.

Place:
Date:

Signature of the Applicant

Please make sure all the required fields are fill out correctly.

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