Application form - TOSHKENT TIBBIYOT AKADEMIYASI TERMIZ FILIALI

Please fill all the areas carefully and check for spelling errors before submitting. This information will be used for applying for visa. Application may be cancelled if your provided information is wrong !

Student ID *

Last name * (If you do not have a last name, write your father`s name)

First name *

Middle name (If you have)

Date of birth *

Passport number *

Telegram number* (Enter the phone number that has telegram account )

Passport Copies* (First and last page in which your living adress is written. Place them in one PDF file and upload)

PDF file (PDF, max. 256KB)

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