REGISTRATION SLIP

APPLICATION NO : SNU228102

CANDIDATE NAME : MOHIT KUMAR GUPTA

ARE YOU INDIAN CITIZEN: YES

ARE YOU DOMICILE OF BIHAR : NO

DO YOU WANT TO CLAIM RESERVATION UNDER

NO
FREEDOM FIGHTER :

B.SC. NURSING FROM ANY NURSING SCHOOL / INSTITUTION RECOGNIZED BY

ESSENTIAL
INDIAN NURSING COUNCIL / HEALTH DEPARTMENT, GOVT. OF BIHAR/ ANY STATE
POST APPLIED FOR : STAFF NURSE QUALIFICATION
NURSING COUNCIL AND THE CANDIDATE SHOULD BE REGISTERED WITH THE
:
NURSING COUNCIL
ARE YOU REGISTER WITH NURSING COUNCIL: YES
NURSING
OTHER STATE NURSING COUNCIL
NURSING COUNCIL NAME : 88747
COUNCIL REGISTRATION
NUMBER :
DATE OF BIRTH : 16-Sep-1991 AGE : 29 YEARS, 3 MONTHS, 16 DAYS
GENDER MALE CATEGORY UR (UN RESERVED)- GENERAL
ARE YOU A PWD WITH 40% OR MORE PERMANENT
NO
DISABILITY ? :
MOBILE
EMAIL ADDRESS : MACMOHIT91@GMAIL.COM 8078657338
NUMBER :
MOTHER NAME
FATHER NAME : PYARE LAL UMA DEVI
:
ID PROOF : AADHAR CARD ID PROOF NO : 416221942374
MARITAL STATUS : UNMARRIED SPOUSE NAME NOT APPLICABLE
ADDRESS FOR COMMUNICATION : NARAYAN NURSING COLLEGE, JAMUHAR, ROHTAS, BIHAR, ROHTAS, 821305
PERMANENT ADDRESS : VIJAY STORES,NEAR REST HOUSE, SAPOTRA, KARAULI, RAJASTHAN, KARAULI, 322218

EDUCATIONAL QUALIFICATIONS

NAME OF THE
QUALIFICATION ACQUIRED BOARD/COUNCIL/UNIVERSITY TO MAXIMUM PERCENTAGE OF
SUBJECT/STREAM YEAR OF PASSING OBTAINED MARKS
/ EXAMINATION PASSED WHICH THE INSTITUTION IS MARKS MARKS
AFFILIATED
KALPNA BAL VIDHYA MANDIR HINDI ENGLISH SCIENCE
XTH / 10TH 2007 600 363 60.50
SEC.SCHOOL SAPOTRA MATHS SANSKRIT

B.SC. NURSING FROM ANY

NURSING SCHOOL /
INSTITUTION RECOGNIZED
BY INDIAN NURSING
COUNCIL / HEALTH
SHREE GURU KRIPA NURSING
DEPARTMENT, GOVT. OF ALL NURSING SUBJECT 2014 2800 2010 71.79
COLLEGE GWALIOR M.P.
BIHAR/ ANY STATE NURSING
COUNCIL AND THE
CANDIDATE SHOULD BE
REGISTERED WITH THE
NURSING COUNCIL

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PAYMENT DETAILS

Amount Paid Payment Status Transaction Number Transaction Date

Rs 500 Success 892801806210645001 18/06/2021 06:32:26 am

 I do hereby undertake that the information furnished in this online application is true. If in future, any of the information furnished by me in this application or any
certificate/document produced by me in support of eligibility conditions laid down in this advertisement is found to be fake or if for any reason I am later found not eligible for the post
applied for, my candidature as well as consequential selection or engagement if any shall be cancelled without notice. In that event, the authorities shall not be held responsible for
cancellation of my candidature/selection/engagement. I shall also be punished as per law for providing false information or producing fake documents.
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