5/5/2021 FMGE June 2021

FMGE June 2021 Session

NOTE : Your Application form has submitted Successfully. Your Payment is successful.

Applicant Details

Personal Details
Application ID

2111119056 Candidate's Name

YATI DILIP PATIL

Father's Name Mother's Name

DILIP PATIL NANDA PATIL

Nationality Are you a Non Resident Indian (NRI) ?

INDIAN NO
Gender

MALE

Date of Birth Have you migrated from another country

13/NOV/1989 NO

Contact Details
Mobile Number

9818726304

Email ID
YATI.PATIL13@GMAIL.COM

Identification Details
Do you have Government of India issued VOTER ID Government of India Issued VOITER ID CARD Number
CARD ?
TTZ6338016
YES

https://g21.digialm.com/EForms/SBIepayAfterPaymentAction.do?70791ZZ1815ZZonline 1/6
5/5/2021 FMGE June 2021

Do you have Government of India issued PAN CARD ?

NO

Do you have Government of India issued DRIVING Do you have Government of India issued PASSPORT ?
LICENSE ?
YES
NO

Government of India Issued PASSPORT Number

H0809491

PASSPORT Validity MARK OF IDENTIFICATION 1 (Birth mark/Body mark)

10/2018 MOLE ON FORHEAD

MARK OF IDENTIFICATION 2 (Birth mark/Body mark)

MOLE ON FOREHEAD

Correspondence Address

Address Line 1

FLAT NO. 4 YOGESHWAR APARTMENT ,

Address Line 2
SHARANPUR ROAD , NEW PANDIT COLONY,GANGAPUR ROAD NASHIK

Country State

INDIA MAHARASHTRA

City/District Pin Code

NASHIK 422002

Is permanent address same as correspondence

address

YES

Permanent Address

Address Line 1
https://g21.digialm.com/EForms/SBIepayAfterPaymentAction.do?70791ZZ1815ZZonline 2/6
5/5/2021 FMGE June 2021

FLAT NO. 4 YOGESHWAR APARTMENT ,

Address Line 2

SHARANPUR ROAD , NEW PANDIT COLONY,GANGAPUR ROAD NASHIK

Country State

INDIA MAHARASHTRA

City/District Pin Code

NASHIK 422002

10+2/Equivalent Exam Details

Sr. No. Subject Percentage/Grade

1 PHYSICS 37

2 CHEMISTRY 36

3 BIOLOGY 48

4 ENGLISH 62

5 GEOGRAPHY 60

Aggregate Percentage in PCB

40.33

Details of MBBS/ Primary Medical Qualification

Country of Completion of Primary Medical Qualification(MBBS)

KYRGYZSTAN

City University/College Name

OSH OSH STATE UNIVERSITY MEDICAL FACULTY

https://g21.digialm.com/EForms/SBIepayAfterPaymentAction.do?70791ZZ1815ZZonline 3/6
5/5/2021 FMGE June 2021

Month and Year of Joining Month and Year of Passing

06/2008 05/2014

Period taken to complete MBBS/Primary Medical

Qualification (as per date of joining and passing
selected by candidate) in months

71

Eligibility Certificate (EC) Details

Do you have eligibility certificate issued by MCI/NMC ? Date of issue of eligibility certificate

YES 28/03/2009

Additional Information
Deported/Rusticated during Medical Course Charged of use of unfair means by NBE/Other
examination body
NO
NO

Have you appeared in FMGE in the past

NO

Test Center Details

State City

MAHARASHTRA MUMBAI

Candidate Images Upload Details

Captured Photo

Uploaded Photo

https://g21.digialm.com/EForms/SBIepayAfterPaymentAction.do?70791ZZ1815ZZonline 4/6
5/5/2021 FMGE June 2021

Signature

Left Thumb Impression

Attachments

To view Primary Medical Qualification Certificate(English Version)Click here.

To view Eligibility Certificate issued by MCI/NMC.Click here.

To view Govt of India issued PassportClick here.

Payment Details
Amount Payment Mode

7080 RS ONLINE

Payment Transaction No Payment Status

6372129889423 PAYMENT SUCCESS

Declaration

https://g21.digialm.com/EForms/SBIepayAfterPaymentAction.do?70791ZZ1815ZZonline 5/6
5/5/2021 FMGE June 2021

FMGE is a proprietary examination and is conducted by the National Board of Examinations. The
contents of this exam are confidential, proprietary and are owned by the National Board of
Examinations. NBE explicitly prohibits the candidate from publishing, reproducing or transmitting
any or some contents of this exam, in whole or in part, in any form or by any means verbal or
written, electronic or mechanical or for any purpose whatsoever. NBE shall not entertain any
request for sharing any content of the examination including Answer Keys/Answer Sheets.

No content of this exam must be shared with friends, acquaintances or third parties including
sharing through online means or via social media. Social media includes but not limited to SMS,
Whatsapp, Facebook, Twitter, Hangouts, Blogs etc using either one’s own account or proxy
account(s).

By registering for and /or appearing in FMGE the candidate explicitly agrees to the above Non
Disclosure Agreement and general terms of use for FMGE as contained in this Information
Bulletin, and FMGE website.

I certify that I have physically attended the course of my primary medical qualification for the
mandated period as per requirement of the University concerned toward award of my primary
medical qualification degree certificate.

Violation of any act or breach of the same shall be liable for penal action and cancellation of the
candidature at the bare threshold.

I certify that I fulfill the eligibility requirements for FMGE/Screening Test and have furnished
complete and correct information. I understand that any instances of furnishing incorrect
information detected during any stage of the examination process will automatically disqualify me
from the examination process and I will not be allowed appear for FMGE/Screening Test in future.

Similarly, if such instances go undetected during the current examination process but, are
detected in subsequent years, such disqualification will take place with retrospective effect.

I also understand that providing incomplete information will automatically disqualify me from the
examination process.I have read the information bulletin and do hereby undertake that I will not
indulge in any unfair means/practice for FMGE/Screening Test I understand that the decision of
NBE shall be final and binding upon me.

Any dispute concerning FMGE would be subject to Jurisdiction of the Competent Courts
exclusively at Delhi/New Delhi only. I will comply with the Non Disclosure Agreement as indicated
in the information bulletin. I certify that I have read the information bulletin thoroughly.

Version 14.01.01

https://g21.digialm.com/EForms/SBIepayAfterPaymentAction.do?70791ZZ1815ZZonline 6/6