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 Additional Qualification पंजीकरण क ितिथ (Register 15/09/2023

Type ) Registration Form Date )

थायी आवेदन सं या (Permanent 45428

Registeration Id)
आवेदन सं या (Application RMC-298952 आवेदन करने क ितिथ 16/08/2023
Number) (Application Date)
आवेदक का नाम (Applicant's DAMINI SHARMA िपता का नाम (Father's Name) SHRI SUBHASH CHANDRA
Name) SHARMA
माता का नाम (Mother's Name) SANTOSH SHARMA वैवािहक ि थित (Marital Status) Single
िलंग (Gender) Female
ज म ितिथ (Date of Birth) 21/03/1996 ईमेल (Email Address) dendeavours@gmail.com
मोबाइल नंबर (Mobile Number) 9461505994 रा ीयता (Nationality) Indian
आधार काड (Aadhar Card) 6592/6490/2945
िनवास (Domicile) Rajasthan अ ययन पूरा हआ (Study Indian
completed)
अ ययन का राज् (State of Study) Rajasthan SSO ID DENDEAVOURS
संदभ यि का नाम (c) Aarzoo संदभ यि का पता (Reference House no. 4656, sector 11,
person address) Jind, Haryana
संदभ यि का नाम (Reference Suresh Jat संदभ यि का पता (Reference Rajarampura, Premnagar,
person name) person address) Amer, Jaipur- 303704
या आप कभी अपराधी ठहराए गए हो? No
(Have you ever been
convicted)

Transaction Details

Transaction ID 23555638375 Transaction Amount ₹ 2000/- Transaction Date 16 Aug, 2023

पते का िववरण (Address Details)

पता पंि 1 (Address Line 1) पता पंि
2 (Address Line 2) पता पंि
3 (Address Line 3)
51/314, PRATAP NAGAR , HOUSING BOARD SANGANER SECTOR-5

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

Rajasthan Jaipur Jaipur

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

JAIPUR 302033

यो यता िववरण (Qualification Details)

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

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

Rajasthan CBSE 2011 1134798 CGPA 10 10.00

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

Rajasthan CBSE PCB 2013 1632043 Marks 500 472.00

िचिक सा यो यता िववरण (Medical Qualification Details)

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

Post DOCTOR OF DR. S.N. RAJASTHAN UNIVERSITY 2020 2023

Graduate MEDICINE(PAEDIATRICS) MEDICAL OF HEALTH SCIENCES,
COLLEGE, JAIPUR
JODHPUR

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.