Registration Form

Apply Date : 24-Feb-2025
Academy Information
Course Applied for Registration : GNM/BSC Nursing
Applicant's Details
Name Mr./Mrs. : ANIL KUMARFather Name : RATAN LAL
Mother Name. : PARWATI DEVIDate Of Birth : 30/07/1997
Age : 27Birth Place : JHUNJHUNU
Religion. : HinduGender : Male
Marital Status : SingleAadhar No : 953636205729
Email : TONUPOOJA776@GMAIL.COMCategory : System.Data.Entity.DynamicProxies.Category_DBFAA33D47C439BDC3DA9BAA2DFF3FD553465B7ED6FBC802B299866C77B41C23
Mobile No : 9460917475Secondary Mobile No : 9460917475
Candidate Corresponse Address
Nationality : IndianRajasthan Domicial : True
State : Rajasthan District : Jhunjhunu
Tehsil : CHIRAWA
Current Address : GOVINDPURA, JHUNJHUNUPincode : 333025
Permanent Address : GOVINDPURA, JHUNJHUNU Pincode : 333025
Basic Eduation Qualification Details
SNo. Exam Board Name Passing Year Subject Percentage/Grade/CGPA Roll No
110thCENTRAL BOARD OF SECONDARY EDUCATION 2013ALL64.601147178
212thBOARD OF SECONDARY EDUCATION, AJMER 2015SCI-BIO59.601577401
Professional Training Details
Registration Required : GNM Training Centre Address : Jhunjhunu
Training Centre Name : SHREE BALAJI NURSING INSTITUTE, SUJANGARH, CHURU Training Duration (Year) : 3
(Training Period) Date From : 19-Feb-2022 To : 27-Jan-2025
Training Exam Details
University Name : RAJASTHAN NURSING COUNCIL, JAIPURPassing Year : 2025
Percentage/Grade/CGPA : 76.55Roll No (Final Year) : 00632
Upload Required Documents
Secondary Marksheet(Original Scan Copy) : Uploaded
Senior Secondary Marksheet(Original Scan Copy) : Uploaded
Marksheet of GNM/ANM/Bsc Nursing(Original Scan Copy) : Uploaded
Aadhar Card(Original Scan Copy) : Uploaded
College Verification Letter : Uploaded
Pay Fees
ReceiptPay DateAmountGST % GST AmountPayPay ModeTransaction IDStatus
201908 24-Feb-2025 2500.00 18.00 450.00 2950.00 upi 744077789 Successed
Declaration

hereby undertake that if i am admitted to Register, i will, in the practice of my profession as a observe and be bound by the provision of the Act and the rules and By-Laws made or order and instruction , issue there under so far as they affected me and in the council shall any time after due enquiry order my name removed from Register. i will return to Register the Certificate and badge (if any) issued to me by Council.

Important Notice

Once a receipt has been generated for other state registration, the said receipt will only be valid for 180 days from the date of generation. ₹3000 + 18% GST applicable.


ANIL KUMAR
APPLICANT'S NAME