DAAI Application Form 2024

Name *Full name as shown in your Medical Registration Certificate

Email Address *

Phone No *

Whatsapp Number *

Date of Birth ( DD-MM-YYYY ) *

Age

Gender *

Citizenship *

Country of current living *

Qualification *

Specialization *Respiratory/Pulmonary MedicineGeneral MedicineGeneral PediatricsENT (Otorhinolaryngology)DermatologyOthers

Qualification / Specialization

Current Designation and Working address *

Correspondence Address *

Number of papers published in indexed journals *

Awards won at National/International level *YesNo

Oral paper or poster presented at National/International level *YesNo

Have you previous applied for DAAI course *YesNo

Previous experience in the field of Allergy *YesNo

Why you want to pursue DAAI course? *

Upload Photo (JPEG FORMAT, MAX. 2 MB) *

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Upload Latest CV (PDF FORMAT. MAX. 2 MB) *

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Upload PG (Diploma/ Degree) Certificate (PDF/JPEG FORMAT, MAX. 2 MB) *

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Upload Medical Registration Certificate (PDF/JPEG FORMAT, MAX. 2 MB) *

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Upload Documents (if any other) (PDF/JPEG FORMAT, MAX. 2 MB)

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Signature (JPEG FORMAT, MAX. 2 MB)

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Upload Proof Of Payment of Application fee of Rs 2000 *

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Evidence of a completed bank transfer

Consent *

I confirm that all the information provided in this application form is accurate and complete to the best of my knowledge. I understand that any false or misleading information may result in the rejection of my application.

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