Application Form For Admission To P.B. B.Sc. Nursing

First Name * :

Father's/Husband's Name * :

Mother's Name * :

Surname * :

Date of Birth * :

Sex * :

Nationality Status * :

Domicile * :

Mobile No * :

Candidate's Photo :

Signature of the candidate :

Academic Details (RGNM) * :

Marks Obtained in R.G.N.M* :

Out Of * :

Year of Passing (R.G.N.M)* :

STD Code / Telephone No * :

College Passed from & Address * :

Address * :

District * :

State * :

Name of Parent/Guardian * :

Address of Parent/Guardian * :

Declaration:

a) I hereby declare that the above information is true and complete to the best of my knowledge. I am aware that if any information herein is found to be incorrect or incomplete, my application form will be rejected/admission will be cancelled.
b) If admitted to this Institution I shall abide by its rules and regulations.
c) I have read and understood all the provisions contained in the brochure and hereby agree to abide by these provisions.