RAJASTHAN MEDICAL COUNCIL, JAIPUR

ONLINE APPLICATION REGISTRATION FORM

RMC REGISTRATION INVOICE

यि गत िववरण (Personal Details)

फोटो (Photograph) ह ता र (Signature)

पंजीकरण का पकार (Register Permanent Registration पंजीकरण क ितिथ (Register 10/10/2022

Type ) Date )

अनंितम आवेदन सं या RMC-253471

(Provisional Registeration
Id)
आवेदन सं या (Application RMC-278401 आवेदन करने क ितिथ 07/09/2022
Number) (Application Date)
आवेदक का नाम (Applicant's SOLANKI JIGNASHA LALIT िपता का नाम (Father's Name) SOLANKI LALIT VASHRAM
Name)
माता का नाम (Mother's Name) SOLANKI DAXA LALIT वैवािहक ि थित (Marital Status) Single
िलंग (Gender) Female
ज म ितिथ (Date of Birth) 07/12/1996 ईमेल (Email Address) jignashahi7@gmail.com
मोबाइल नंबर (Mobile Number) 8696478021 रा ीयता (Nationality) Indian
आधार काड (Aadhar Card) 9220/7602/4826
िनवास (Domicile) DAMAN AND DIU अ ययन पूरा हआ (Study Indian
completed)
अ ययन का राज् (State of Study) Rajasthan SSO ID JIGNASHAHI7
संदभ यि का नाम (c) SOLANKI LALIT VASHRAM संदभ यि का पता (Reference D-8,APHHA VILLA ROW
person address) HOUSE,DILIP NAGAR,DAMAN
संदभ यि का नाम (Reference SOLANKI CHIRAG LALIT संदभ यि का पता (Reference D-8,APHHA VILLA ROW
person name) person address) HOUSE,DILIP NAGAR,DAMAN
या आप कभी अपराधी ठहराए गए हो? No
(Have you ever been
convicted)

Transaction Details
Transaction ID 22469219647 Transaction Amount ₹ 2000/- Transaction Date 07 Sep, 2022

पते का िववरण (Address Details)

पता पंि 1 (Address Line 1) पता पंि 2 (Address Line 2)
H.No. 14-79/B/1/G-15,D-8,Alpha Villa Row Near Dilip Nagar Ground,Nani Daman
House

रा य (State) िजला (District) लॉक/तहसील (Block/Tehsil)

DAMAN AND DIU DAMAN AND DIU

शहर / गाँव (City/Village) िपन कोड (Pincode)

DAMAN 396210

यो यता िववरण (Qualification Details)

10 व क यो यता िववरण (10th Qualification Details)

Year of Roll Marks Final Maximum Final Marks

State of Study Board/Council Passing Number Obtained Marks Obtained

DAMAN AND Gujarat Board 2012 581743 Marks 500 402.00

DIU

वर मा यिमक यो यता िववरण (Senior Secondary Qualification Details)

 State of Science Year of Roll Marks Final Maximum Final Marks
Study Board/Council Stream Passing Number Obtained Marks Obtained

DAMAN AND Gujarat Board PCB 2014 785471 Marks 700 575.00
DIU

िचिक सा यो यता िववरण (Medical Qualification Details)

Final Final
Name & Address of Year of Year Year
Course the Name of the admission/ Year of Marking Maximum Marks
Types Course College/Institute University/Board/Council Batch Passing Schema Marks Obtained

Under M.B.B.S. PACIFIC INSTITUTE SAI TIRUPATI UNIVERSITY, 2016 2021 Marks 900 524.00
Graduate OF MEDICAL UDAIPUR
SCIENCES,UMARDA
UDAIPUR

आवेदक घोषणा (Applicant undertaking)

I here by declare that the information given above and in the enclosed documents is true to the best of my knowledge and belief and nothing
has been concealed therein. I am well aware of the fact that if the information given by me is proved false / not true, I will have to face the
punishment as per the law. Also all the benefits availed by me shall be summarily withdrawn.

िचिक सा नैितकता घोषणा (Medical Ethics undertaking)

I solemnly pledge myself to consecrate my life to service of humanity., Even under threat, I will not use my medical knowledge contrary to the
laws of Humanity., I will maintain the utmost respect for human life from the time of conception., I will not permit considerations of religion,
nationality, race, party politics or social standing to intervene between my duty and my patient., I will practice my profession with conscience
and dignity., The health of my patient will be my first consideration., I will respect the secrets which are confined in me., I will give to my
teachers the respect and gratitude which is their due., I will maintain by all means in my power, the honour and noble traditions of medical
profession., I will treat my colleagues with all respect and dignity., I shall abide by the code of medical ethics as enunciated in the Indian
Medical Council (Professional Conduct, Etiquette and Ethics) Regulations 2002. I make these promises solemnly , freely and upon my
honour.

घोषणा (DECLARATION FOR FURNISHING SELF-ATTESTED IN LIEU OF ORIGINAL DEGREE)

I, DR SOLANKI JIGNASHA LALIT D/o SOLANKI LALIT VASHRAM aged 24 year(s) resident of H.No. 14-79/B/1/G-15,D-8,Alpha Villa Row
House Near Dilip Nagar Ground,Nani Daman , DAMAN AND DIU, DAMAN - 396210 make the following statement on oath:-
1. That, I have passed the M.B.B.S. examination from PACIFIC INSTITUTE OF MEDICAL SCIENCES,UMARDA UDAIPUR in the year of
2021.
2. That, I have completed my Internship training of one year from To at PACIFIC INSTITUTE OF MEDICAL SCIENCES Hospital.
3. That, I have not, as yet been awarded the Original M.B.B.S. Degree by the SAI TIRUPATI UNIVERSITY, UDAIPUR
4. That, I shall submit the Original M.B.B.S Degree to the Registrar, Rajasthan Medical Council as soon as it is awarded to me.
5. That the facts stated above are true and correct to the best of my knowledge and belief and nothing is concealed.