Chhattisgarh Nurses Registration Council Raipur Chhattisgarh Website: www.cgnre.org, Phone-0771-2227600 RE-EVALUATION FORM COURSE- Oe year... sonjecs- 1 COPUMUNELY.. HEALTHn NURSING | ‘The Registrar / Chhattisgarh Nurses Registration Counc MI Raipur Chhatusgarh Torourh: Prins Senor Sister Tuer charge Ser Tutor, Sehot of Nursing ALM ALPUR RAIPUR Madam, | request permission to present myself at the ensuing Re-evaluation for ANM-I// ANM-IL/ GNM-I/ GNM-Il / GNM- UI Course. ‘The sum of Rs, 200-00 is every subject+ Rs S000 form fee forwarded herewith as Re totaling fee through Online payment mode. eee AL DETAILS 1. Name (in capita eter « Risa. XEXONA.. KALE T 2. Father nme... MVOAKAR KALET. 3. daw orBinn AM = UL 1496, ge. 2B. URE. 4. Roll Number... 270.23, 5. Borotiment Numbgt IZLE. sce 6 Name ofsininginstintion ODERN.. MEPL COL. . INSTLTVIE.... ACHOOK...O NURBING AAMUR ROEPUR (C4) 7. Permanent residential Address in fist Place . eves Date... Signt pplicant Signature of Principal Signature of Receiver Signature of Approving Authority©sBI CHHATTISGARH NURSES REGISTRATION COUNCIL RAIPUR OLD NURSES HOSTEL OLD DIRECTORATE OF HEALTH SERVICES DKS PARISAR RAIPUR CG LL NO 0771 2227600, , RAIPUR-492001 Date: 12-Jun-2020 -Receipt for State Bank Collect Payment s8collect Reference Number Dupos21696 Bank Reference Number Icartuvay7 category STUDENT FEE COLLECTION Name of the Gancdate REXONA KALET Father or Husband Name DIWAKAR KALET courses nm category sc Mobie Number ° 8815357041 Date of ith sar1r1996 Fee Tp Exam Fee ‘mount 200 Tanastion charge 11.20 Tota Amount Figures) 211.80 Tota Amount dn Words) Rupees Two Hundred Eleven and Palse Eighty Only remarks Netieaion Notification 2OsBI CHHATTISGARH NURSES REGISTRATION COUNCIL RAIPUR (OLD NURSES HOSTEL OLD DIRECTORATE OF HEALTH SERVICES DKS PARISAR RAIPUR CG LL NO 0771 2227600, , RAIPUR-492001 Date: 12-Jun-2020 e-Receipt for State Bank Collect Payment ‘sBColect Reference Number DuD0930033, ‘Bank Reference Number IgarTvaris category STUDENT FEE COLLECTION Name of the Candidate REXONA KALET Father or Husband Name DIWAKAR KALET Courses GNM ‘category sc Mobile Number ~ ge15367041 Date of ith 14/11/1996 Fee Type Exam Fe ‘Amount 50 “Transaction charge 11.80 “otal Amount (In Figures) 61.80 ‘Total Amount (n Words) Rupees Sixty One and Paise Eighty Only Remarks Notication 4 Notification 2