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Form No
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MPNRC4023
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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 : |
14/10/2022 |
| INSTITUTE NAME : |
R M D JAIN INSTITUTE OF NURSING, BHOPAL (07169) Bhopal |
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| APPLICANT NAME : |
PRITY KUMARI |
DATE OF BIRTHDAY : |
21/07/2004 |
| GENDER : |
Female |
AGE : |
20 Y, 1 M, 25 D |
| FATHER'S NAME : |
PUNIT SINGH |
CASTE : |
HINDU |
| MOTHER'S NAME : |
SEEMA DEVI |
CATEGORY : |
UR |
| RELIGION : |
HINDU |
MARITAL STATUS : |
Single |
| MOBILE : |
6201027181 |
E-MAIL : |
SINGHPRITEE@GMAIL.COM |
| CURRENT ADDRESS : |
HOSTEL MIMS CAMPUS BHOPAL |
| PERMANENT ADDRESS : |
KASIAWAN ROHTAS 821303 |
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| TOTAL FEE : |
₹ 240 |
PAYMENT STATUS : |
TXN_SUCCESS |
| TRANSACTION ID : |
20240529210430000002559085084181483 |
TRANSACTION DATE : |
29 May 2024 12:52:00:000 |
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| S.N |
EXAM NAME |
BOARD NAME |
STATE |
SUBJECTS |
PASS YEAR |
PERCENTAGE |
| 1 |
High School (10th) |
BIHAR BOARD |
BIHAR |
ALL SUBJECT |
2020 |
70 |
| 2 |
High Secondary School (12th) |
BIHAR BOARD |
BIHAR |
BIOLOGY |
2022 |
60.6 |
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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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