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Form No
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MPNRC2873
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| ENROLLMENT APPLICATION FORM |
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| ENROLLMENT NO : |
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PHOTO & SIGNATURE |
| CURRENT STATUS : |
Approved |
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| APPLIED COURSE : |
GNM New First Year |
| APPLIED SESSION : |
2022-23 |
| DATE OF ADMISSION : |
06/02/2024 |
| INSTITUTE NAME : |
Mahatma Gandhi Institute of Nursing (21111) Jabalpur |
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| APPLICANT NAME : |
RIYA TIWARI |
DATE OF BIRTHDAY : |
04/07/2005 |
| GENDER : |
Female |
AGE : |
19 Y, 2 M, 17 D |
| FATHER'S NAME : |
DAYARAM TIWARI |
CASTE : |
PANDIT |
| MOTHER'S NAME : |
SAVITRI |
CATEGORY : |
UR |
| RELIGION : |
HINDU |
MARITAL STATUS : |
Single |
| MOBILE : |
9977968850 |
E-MAIL : |
rt490074@gmail.com |
| CURRENT ADDRESS : |
110/3 KUVAR JI KA BADA MAHARSHI ARVIND WARD-17 HIGH COURT JABALPUR 482007 |
| PERMANENT ADDRESS : |
110/3 KUVAR JI KA BADA MAHARSHI ARVIND WARD-17 HIGH COURT JABALPUR 482007 482007 |
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| TOTAL FEE : |
₹ 240 |
PAYMENT STATUS : |
TXN_SUCCESS |
| TRANSACTION ID : |
20240530210460000003001717128630181 |
TRANSACTION DATE : |
30 May 2024 18:11:00:000 |
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| S.N |
EXAM NAME |
BOARD NAME |
STATE |
SUBJECTS |
PASS YEAR |
PERCENTAGE |
| 1 |
High School (10th) |
MP BOARD |
MADHYA PRADESH |
ALL |
2020 |
76.25 |
| 2 |
High Secondary School (12th) |
MP BOARD |
MADHYA PRADESH |
MATHS SCIENCE |
2022 |
65.8 |
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| 10TH MARKSHEET |
12TH MARKSHEET |
AADHAAR CARD |
CAST CERTIFICATE |
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I hereby declare that the entries made by me in the Application Form are complete and true to the best of my knowledge, belief and information.
I hereby accept that the information provided in the application form will not be altered in the foreseeable
future
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STUDENT SIGNATURE |
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