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Form No
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MPNRC06334
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| ENROLLMENT APPLICATION FORM |
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| ENROLLMENT NO : |
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PHOTO & SIGNATURE |
| CURRENT STATUS : |
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 |
| APPLIED COURSE : |
GNM New First Year |
| APPLIED SESSION : |
2022-23 |
| DATE OF ADMISSION : |
30/01/2023 |
| INSTITUTE NAME : |
Sailana College Of Nursing (34109) Ratlam |
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| APPLICANT NAME : |
PAWAN |
DATE OF BIRTHDAY : |
18/07/1997 |
| GENDER : |
Male |
AGE : |
27 Y, 1 M, 25 D |
| FATHER'S NAME : |
JEETRAM |
CASTE : |
PUNJABI |
| MOTHER'S NAME : |
BALA |
CATEGORY : |
UR |
| RELIGION : |
HINDU |
MARITAL STATUS : |
Single |
| MOBILE : |
9917796895 |
E-MAIL : |
sailanacollegeofnursing@gmail.com |
| CURRENT ADDRESS : |
MAKAN NO 1008, WARD NO 12, BANSWAN, NEAR KHEER SAGAR, BANSWAN, PALWAL, HARYANA 121107 |
| PERMANENT ADDRESS : |
MAKAN NO 1008, WARD NO 12, BANSWAN, NEAR KHEER SAGAR, BANSWAN, PALWAL, HARYANA 121107 121107 |
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| TOTAL FEE : |
₹ 240 |
PAYMENT STATUS : |
TXN_SUCCESS |
| TRANSACTION ID : |
20240606210470000005503824981352237 |
TRANSACTION DATE : |
06 Jun 2024 15:53:00:000 |
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| S.N |
EXAM NAME |
BOARD NAME |
STATE |
SUBJECTS |
PASS YEAR |
PERCENTAGE |
| 1 |
High School (10th) |
HARYANA BOARD |
HARYANA |
ALL |
2013 |
67.4 |
| 2 |
High Secondary School (12th) |
HARYANA BOARD |
HARYANA |
BIOLOGY |
2014 |
60 |
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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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