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All India Institute of Medical Sciences

Ansari Nagar, New Delhi - 110608
APPLICATION FORM - Nursing Officer Recruitment Common Eligibility Test (NORCET-6)

Candidate Profile Candidate ID: 6161579058 Registration No: 52083502 Registration Date: 13/03/2024

Candidate Name: SHASHI PRABHA PAL Date of Birth: 01 Jan 1994

Gender: Female Category: OBC (NCL)

Father's Name: CHHOTE LAL PAL Mother's Name: ITWARI DEVI

Persons with Benchmark Disability Status: No PWBD Category: NA

Nationality: INDIAN State of Domicile: UTTAR PRADESH

Applied for :
Nursing Officer Recruitment Common Eligibility Test (NORCET-6)

Are you a Government Employee : No

Are you a Ex-Service men : No

Contact Details

Address for Permanent: Correspondence Address:

HARIOM NAGAR,ALI NAGAR SUNAHRA, ASHARAM BAPU HARIOM NAGAR,ALI NAGAR SUNAHRA, ASHARAM BAPU
ROAD,MANAS NAGAR,LUCKNOW,UTTAR PRADESH, , , Manasnagar , ROAD,MANAS NAGAR,LUCKNOW,UTTAR PRADESH, , , Manasnagar ,
UTTAR PRADESH, India, 226023 UTTAR PRADESH, India, 226023

Mobile No: 1. 6266441915 , 2. No E-Mail ID: PALKHUSHI645@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 JIWAJI UNIVERSITY MOTHER TERESA 01/08/2014 30/11/2018
Council recognized Institute or University GWALIOR INSTITUTE OF NURSING

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 17243 17234 UTTAR PRADESH 17/08/2021

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

ID Proof: Adhar Card ID No: 408084752299 Place of Issue: INDIA Issue Date: NA Valid Till: NA

Payment Details

Mode: Online Date: 19/03/2024 Transaction ID: 15790581209 Amount: 3000

Do you have experience : No

Examination City Opted:

Exam City (Preference 1):
State: State : Exam City (Preference 2): State : Exam City (Preference
Delhi/ NCR (Delhi, Noida, Faridabad,
DELHI UTTAR PRADESH LUCKNOW UTTAR PRADESH 3): KANPUR
Ghaziabad)

UNDERTAKING/DECLARATION: I hereby declare that the information furnished by me in the Registration/Application Form is correct and nothing has been

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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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