All India Institute of Medical Sciences

Ansari Nagar, New Delhi - 110608

Registration Form - Institute of National Importance Combined Entrance Test (INI-CET) for admission to PG courses [MD/MS/M.Ch.(6years)/DM(6years)/MDS] July
2024 Session

Candidate Profile Registration ID: P6211621133 Payment ID: 30058166 Examination Unique Code: 9571225

Candidate Name: KUDIKALA VENKAT SAI Applied Course: MD/MS/MCH(6YRS)/DM(6YRS)

Date of Birth: 03 Dec 1998 Category: OBC (NCL)

Gender: Male Marital Status: Unmarried

Father's Name: KUDIKALA CHANDRA MOULI Mother's Name: KUDIKALA CHANDRAKALA

PWBD Status: No PWBD Category: NA

Nationality: INDIAN Applied Under: Indian National

Identification Mark(1): A MOLE ON RIGHT WRIST Identification Mark(2):

A MOLE ON RIGHT ELBOW

Are you currently pursuing PG Course in any Subject: NO Do you belong to Karnataka Domicile Category:
NO

Do you belong to North East Domicile Category: NO Do you want to apply for Bhutani National
Candidate : NA

Service in Armed Forces (as per note 3 of Appendix-E)?: NA Service in Central/State Govt. of 3 years or more
(as per note 3 of Appendix-E)? : NA

Applied for PGIMER,Chandigarh under Sponsored Category (Indian National)?: NA Applied for JIPMER,Puducherry under
Sponsored Category (Indian National)? : NA

Applied for AIIMS under Sponsored Category (Indian National)?: NA

Applied for SCTIMST, Trivandrum under Sponsored Category (Indian National)?: Do you want to apply for NIMHANS,Bengaluru
NA under Sponsored Category(Indian National) : NA

Contact Details

Address for Permanent: Correspondence Address:

33-6-150 , RAHEMATH NAGAR 3RD STREET , RANGSHAIPET WARANGAL, 33-6-150 , RAHEMATH NAGAR 3RD STREET , RANGSHAIPET WARANGAL,
Warangal , Warangal, TELANGANA, India, 506002 Warangal , Warangal, TELANGANA, India, 506002

Mobile No: 1. 7989455976 , 2. Alternate-MobileNo 9059840597 E-Mail ID: venkatsaikudikala@gmail.com

Qualification Details

Qualifying Examination Degree From State Name Admission Date Passing Date

MBBS Indian University Telangana 26/09/2016 31/05/2021

University Name Institute/College Name

KALOJI NARAYANA RAO UNIVERSITY OF HEALTH SCIENCES Kakatiya Medical College, Warangal

Academic Details

Qualifying Exam Max Marks Marks Obtained Percentage(%)

MBBS 2450.00 1535.00 62.65

Internship Details

Internship Status Internship Start Date Completion/Expected Completion Date No. of Days
Completed 01/06/2021 31/05/2022 365

Medical Registration Details

Registration Type Registration Date Registration Number Registering Authority

Permanent 17/10/2022 TSMC/FMR/22534 State Council -- (Telangana )

Valid Photo Identity (To be presented in original at the Examination Center along with Admit Card)
ID Proof: Adhar Card ID No: 892065458480 Place of Issue: India Issue Date: NA Valid Till: NA

Do you have experience : No

Payment Details

Mode: Online Date: 11/04/2024 Transaction ID: 16211331214 Amount: 4000

Examination City Opted:

State: Exam City(Preference 1): State : Exam City(Preference 2): State : Exam City(Preference 3): Exam City(Preference 4):

TELANGANA HYDERABAD TELANGANA WARANGAL TELANGANA KARIMNAGAR Any Other City

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