10/25/21, 9:35 PM https://norcet2021.aiimsexams.ac.

in/RegistrationSlip

All India Institute of Medical Sciences

Ansari Nagar, New Delhi - 110608
APPLICATION FORM - Nursing Officer Recruitment Common Eligibility Test (NORCET) - 2021

Candidate Profile Candidate ID:

5941069520 Registration No:
52054150 Registration Date:
25/10/2021

Candidate Name:
CHRISTIREBECAL D Date of Birth:
18 Jul 1995

Gender:
Female Category:
OBC (NCL)

Father's Name:
DANIEL F Mother's Name:
JEGAJOTHI D

Persons with Benchmark Disability Status:

No PWBD Category:
NA

Nationality:
INDIAN State of Domicile:
PONDICHERRY

Applied for :
Nursing Officer Recruitment Common Eligibility Test (NORCET) - 2021

Are you a Central Government Employee : No

Are you a Ex-Service men : No

Contact Details

Address for Permanent: Correspondence Address:

NO.1O, 3RD CROSS, RAVICHANDRAN NAGAR,, THIRUVANDARKOIL,, NO.1O, 3RD CROSS, RAVICHANDRAN NAGAR,, THIRUVANDARKOIL,,
PONDICHERRY, Thiruvandarkoil , PONDICHERRY, India, 605102 PONDICHERRY, Thiruvandarkoil , PONDICHERRY, India, 605102

Mobile No: 1.
8072067990
,        2.
Alternate-MobileNo
9443184405 E-Mail ID:
christidaniel1995@gmail.com

Qualification Details

Qualifying Exam University Name Collage Name Admission Passing

Date Date

B.Sc (Hons.) Nursing / B.Sc Nursing from an Indian Nursing PONDICHERRY SRI MANAKULA VINAYAGAR 03/09/2012 06/09/2016
Council recognized Institute or University UNIVERSITY NURSING COLLEGE

Registration Number with Nursing Council of India/State Nursing Council

Registered as Registration No:(Nurse) Registration No.: (Midwife) State Name of Nursing Council: Issuing Date of Registration:

Nurse and Midwife 170619 170619 TAMIL NADU 12/09/2016

Valid Photo Identity (To be presented in original at the Examination Center along
with Admit Card)

ID Proof:
Adhar Card ID No:
391138522162 Place of Issue:
INDIA Issue Date:
NA Valid Till:
NA

Payment Details

Mode:
Online Date:
25/10/2021 Transaction ID:
8106952066 Amount:
3000

Do you have experience : No

Examination City Opted:

State: Exam City (Preference 1): State : Exam City (Preference 2): State : Exam City (Preference 3):
TAMIL NADU CHENNAI TAMIL NADU COIMBATORE TAMIL NADU NAGERCOIL

UNDERTAKING/DECLARATION: I hereby declare that the information furnished by me in the Registration/Application Form is correct and nothing has been
concealed. In case any information furnished by me is found to be false/incorrect/untrue than i shall be liable to civil/criminal prosecution and my claim to
admission/appointment/registration/ service in the Institute may be cancelled/terminated.

Signature of Candidate
Thumb of Candidate
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