MGM MEDICAL COLLEGE, INDORE

IDENTITY CARD OF UNDER GRADUATE STUDENTS

(TO BE FlLLED IN BLOCK CAPITAL LETTERS)

1. Name : JUHEE UPADHYAY

2. Father’s Name :. ASHISH UPADHYAY
3. Date of birth :. 05/12/1997
4. Age / Sex :. 20/F
5. Blood Group. : A+
6. Prof. Year :. SECOND
7. Year of Admission :. 2016
8. Card Valid up to :. 2022
(Internship completion)

Permanent Address :: 52 MUKHERJI MARG , JUNA BIAORA,

BIAORA

Present Address : MGM GIRLS HOSTEL, WHITE CHURCH COLONY,

INDORE

Mobile No. : 9754080980

E-Mail :dajuhee@gmail.com

Enrolment No. : MG004000016125

Date: 26/03/18

STUDENT’S SIGNATURE
Signature & Name of Signature & Name
concern Clerk with Seal With Seal of
of Student Section Nodal Officer I Card
(Dr.Manohar Bhandari)