Government of Jammu & Kashmir

SHER-I-KASHMIR INSTITUTE OF MEDICAL SCIENCES

Soura, Srinagar-190011
APPLICATION FORM FOR ADMISSION IN B.SC COURSES

Application No. 2755

Space for the latest
photograph of the
The candidates are required to submit payment challan
candidate attested by
of fee in the office of Administrative Officer
Head of Institution
(Academic), SKIMS, Soura, Srinagar by registered post
last attended or
only upto last date of submission of online application
Gazzetted Officer
forms..

Name of the course applied: B.Sc. under Advertisement 20 (ACAD) OF

2019 Dated: 09-12-2019 Submitted on: 20-12-2019 08:12 am
Jammu and Kashmir Dated:
Name of Bank: Tran. No: DC72562
BankSKIMSS(0342) 20/12/2019
Name: IRFAN NAZIR
S/O, D/O, W/O: NAZIR AHMAD LONE
NEHAMA PAMPORE PULWAMA
Permanent Address:
192121
NEHAMA PAMPORE PULWAMA
Contact Address:
192121
Gender: Male Date of Birth: 10/10/1998 Age: 21
Whether
Marital Contact 7006702906(M)
Single Presently No
Status: Number: 9682629901(LL)
In-service:
Category: RBA
Email ITSHILAL@YHAOO.COM
Academic Qualification
Name of the
Examination Institution/ Date of Marks
S. % age
Passed College Passing Obtained
No.
/Board/etc.
1 Matric JKBOSE 2013 304/500 60.8
10+2
2 JKBOSE 2015 252/500 50.4
Science(Medical)
I hereby declare that:
1. The statements made, information, furnished in this application form and the
enclosures submitted by me are true and correct.
Declaration 2. I have not concealed any information and in the event of any of the particulars
By Candidate or information given hereinabove is found incorrect or false, my candidature
for the course of B.Sc. may be cancelled.
3. In the event any mis -statement/discrepancy is found at the time of recruitment
or at later stage, my selection may be cancelled.
Yes, I accept the above declaration
Signature of Candidate