NEET - PG 2021 

Applicant Details

Personal Details

Application Seq No Candidate's Name

PG021529 SHISHUPAL SINGH SHAKYA

Father's Name Mother's Name

PARIMAL SINGH SHAKYA KALAVATI DEVI

Nationality Are you a Non Resident Indian (NRI) ?

INDIAN No

Gender Date of Birth

MALE 11/Jun/1989

Religion Category
HINDU SC

Place of Birth Are you a person with disability ?

 VILLAGE- CHHERA TEH. JOURA NO

Are You Willing to Take up Post Graduate Courses in Armed Forces Medical Service Category
Armed Forces Medical Services Institutions
Serving Officers of the AFMS
YES

Contact Details

Mobile Number Alternate Mobile Number

9575060996 7694026852

Email ID
SPSINGH2440@GMAIL.COM

Identification Details

Do you have Government of India issued AADHAAR Government of India Issued AADHAAR CARD Number
CARD ?
620245550905
YES

Do you have Government of India issued PAN CARD ? Government of India Issued PAN CARD Number
YES CPGPS2672B

Do you have Government of India issued DRIVING Do you have Government of India issued PASSPORT ?
LICENSE ? NO
NO
 MARK OF IDENTIFICATION 1 (Birth mark/Body mark) MARK OF IDENTIFICATION 2 (Birth mark/Body mark)
ONE MOLE ON RIGHT SIDE OF NECK OLD CUT MARK ON LEFT SIDE EYEBROW

Correspondence Address

Address Line 1
VILLAGE AND POST CHHERA

Address Line 2
TEHSEEL- JOURA

Country State
INDIA MADHYA PRADESH

City/District Pin Code

MORENA 476221

Is Permanent Address same as Correspondence

address?
YES

Permanent Address
 Address Line 1
VILLAGE AND POST CHHERA

Address Line 2
TEHSEEL- JOURA

Country State
INDIA MADHYA PRADESH

City/District Pin Code

MORENA 476221

Academic Details

State/UT of Completion of Class 10th

MADHYA PRADESH

State/UT of Completion of Class 12th

MADHYA PRADESH

MBBS Details

Country of completion of MBBS Qualification

 INDIA

State/UT
MADHYA PRADESH

City University of Completion

REWA OTHERS

University Name Name of College

A P S UNIVERSITY, REWA OTHERS

Other College Date of Passing

SHYAM SHAH MEDICAL COLLEGE,REWA 09/01/2019

Internship Details

Have you completed Internship

YES

City of Internship
REWA

Institute of Internship Date of start of Internship

 SHYAM SHAH MEDICAL COLLEGE,REWA 01/01/2019

Date of completion of Internship

31/12/2019

Medical Council Registration Details

MCI/SMC Registration Type

PERMANENT

MCI/SMC Registration Number

MP25889

State/UT of Registration
MADHYA PRADESH

Registration Medical Council

MADHYA PRADESH MEDICAL COUNCIL

MBBS EXAMINATION MARKS

1st MBBS Examination-Percentage of marks obtained

53.1
 2nd MBBS Examination-Percentage of marks obtained
54.7

Final MBBS Examination-Percentage of marks obtained Aggregate Percentage of marks obtained in All MBBS
Professional Examinations
55.5
54.7

Additional Information

Deported/Rusticated during Medical Course Charged of use of unfair means by NBE/Other

NO examination body
NO

Have you appeared in NEET PG previously Previous Roll No.

YES 2066138811

Year of appearing
01/2020

Test Center Details

State City
MADHYA PRADESH GWALIOR
Payment Details

Amount Payment Mode

3835 online

Payment Transaction No Payment Status

2428199913232 S

Candidate Images Upload Details

Captured Photo

Uploaded Photo

Signature
 Left Thumb Impression

Attachments

To view MCI/SMC registration

certificate of MBBS
QualificationClick here.

Declaration
NEET PG is a proprietary examination and is conducted by the National Board of Examinations. The
contents of this exam are confidential, proprietary and are owned by the National Board of
Examinations. NBE explicitly prohibits the candidate from publishing, reproducing or transmitting any
or some contents of this exam, in whole or in part, in any form or by any means verbal or written,
electronic or mechanical or for any purpose whatsoever. NBE shall not entertain any request for
sharing any content of the examination including Answer Keys/Answer Sheets.

No content of this exam must be shared with friends, acquaintances or third parties including sharing
through online means or via social media. Social media includes but not limited to SMS, Whatsapp,
Facebook, Twitter, Hangouts, Blogs etc using either one’s own account or proxy account(s).

By registering for and /or appearing in NEET PG the candidate explicitly agrees to the above Non
Disclosure Agreement and general terms of use for NEET PG as contained in this Information Bulletin,
and NEET PG website.
I certify that I have physically attended the course of my primary medical qualification for the
mandated period as per requirement of the University concerned toward award of my primary
medical qualification degree certificate.

Violation of any act or breach of the same shall be liable for penal action and cancellation of the
candidature at the bare threshold.

I certify that I fulfill the eligibility requirements for NEET PG and have furnished complete and correct
information. I understand that any instances of furnishing incorrect information detected during any
stage of the examination process will automatically disqualify me from the examination process and I
will not be allowed appear for NEET PG in future.

Similarly, if such instances go undetected during the current examination process but, are detected in
subsequent years, such disqualification will take place with retrospective effect.

I also understand that providing incomplete information will automatically disqualify me from the
examination process.I have read the information bulletin and do hereby undertake that I will not
indulge in any unfair means/practice for NEET-PG I understand that the decision of NBE shall be final
and binding upon me.

Any dispute concerning NEET PG would be subject to Jurisdiction of the Competent Courts exclusively
at Delhi/New Delhi only. I will comply with the Non Disclosure Agreement as indicated in the
information bulletin. I certify that I have read the information bulletin thoroughly."

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