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State AYUSH Society, Manipur
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NEET-UG 2026
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APPLICATION FORM FOR AYUSH COURSES (BAMS & BHMS) OPEN COUNSELING OF CANDIDATESFROM NEET – UG 2026 QUALIFIED CANDIDATE(S) FOR GOVERNMENT NOMINATIONIN DIFFERENT AYUSH COLLEGES/ INSTITUTEFOR THE ACADEMIC SESSION 2026-27.
FULL NAME OF THE CANDIDATE
(EXACTLY AS ENTERED IN X/XII STANDARD MARKS):
*
Valid.
Please fill in this field.
SEX:
*
Male
Female
Valid.
Please fill in this field.
CATEGORY:
*
General
Schedule Tribe
Schedule Caste
OBC Meitei/Meetei
OBC Meitei Pangal
Others
Valid.
Please fill in this field.
MOBILE NUMBER:
*
Valid.
Please fill in this field.
EMAIL ADDRESS:
*
Valid.
Please fill in a valid email address.
SPECIAL CATEGORY:
Not Applicable
Children of Armed forces Personnel/Ex Servicemen
Meritorious Sport Person
Person with Disability
Valid.
Please fill in a valid email address.
PERMANENT ADDRESS:
*
Valid.
Please fill in this field.
DISTRICT:
*
Bishnupur
Chandel
Churachandpur
Imphal East
Imphal West
Jiribam
Kakching
Kamjong
Kangpokpi
Noney
Pherzawl
Senapati
Tamenglong
Tengnoupal
Thoubal
Ukhrul
Valid.
Please fill in this field.
PINCODE:
Valid.
Please fill in this field.
PRESENT ADDRESS:
*
(SAME AS PERMANENT ADDRESS)
Valid.
Please fill in this field.
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
Valid.
Please fill in this field.
MONTH:
1
2
3
4
5
6
7
8
9
10
11
12
Valid.
Please fill in this field.
YEAR:
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
Valid.
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AGE ON 31-12-2026:
*
Valid.
Please fill in this field.
NATIONALITY:
*
Valid.
Please fill in this field.
BIRTH PALACE:
*
Valid.
Please fill in this field.
DOMICILE STATUS
(By Birth):
*
Yes
No
Valid.
Please fill in this field.
EITHER OF THE PARENTS ARE CONTINUOUSLY RESIDENT IN MANIPUR FOR MORE THAN 20 YEARS:
*
Yes
No
Valid.
Please fill in this field.
EITHER OF THE PARENTS ARE IN STATE GOVT. SERVICE OR AN INSTITUTION WHICH IS A BODY SUBSTANTIALLY OWNED OR CONTROLLED BY THE GOVT. OF MANIPUR:
*
Yes
No
Valid.
Please fill in this field.
FATHER NAME:
*
Valid.
Please fill in this field.
GUARDIAN'S NAME
(IF FATHER IS NOT ALIVE):
MARKS OBTAINED IN:
(a)10+2 SCIENCE OR EQUIVALENT EXAMINATION
*
SUBJECT:
MARKS OBTAINED :
PASS MARK :
MARKS ALLOTED:
PERCENTAGE OF MARKS OBTAINED:
ENGLISH:
Valid.
Please fill in this field.
Valid.
Please fill in this field.
Valid.
Please fill in this field.
Valid.
Please fill in this field.
PHYSICS:
Valid.
Please fill in this field.
Valid.
Please fill in this field.
Valid.
Please fill in this field.
Valid.
Please fill in this field.
CHEMISTRY:
Valid.
Please fill in this field.
Valid.
Please fill in this field.
Valid.
Please fill in this field.
Valid.
Please fill in this field.
BIOLOGY:
Valid.
Please fill in this field.
Valid.
Please fill in this field.
Valid.
Please fill in this field.
Valid.
Please fill in this field.
NAME OF INSTITUTE (WITH ADDRESS):
*
Valid.
Please fill in this field.
UNIVERSITY / BOARD:
*
Valid.
Please fill in this field.
(b) B. Sc. WITH ANY TWO OF THE SUBJECTS (PHYSICS, CHEMISTRY, BOTANY & ZOOLOGY):
SUBJECT:
MARKS OBTAINED:
MARKS ALLOTED:
PERCENTAGE OF MARKS OBTAINED:
PHYSICS:
Valid.
Please fill in this field.
CHEMISTRY:
BOTANY:
ZOOLOGY:
NAME OF INSTITUTE
(With address):
UNIVERSITY / BOARD:
(c) RANK OF NATIONAL ELIGIBILITY-CUM-ENTRANCE TEST (NEET/UG), 2026 :
*
Valid.
Please fill in this field.
I hereby solemnly affirm that the information furnished above by me is true and correct to the best of my knowledge. I have not kept any information secret. Should it however be found that any informatiom furnished therein is fraudulant, incorrect or untrue in the material particulars, I realize that I am liable to criminal prosecution and I also agree to forego/cancel any allotted seat in AYUSH College. I agree to bide by Rules and Regulations governing the examination and contained in the Manipur AYUSH Entrance Examination (Selection of Candidates for Nomination) Rules 2016 and its subsequent ammendments.
Valid.
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