Registration No:

2021400272

System ID: 2021400272 Application No:00203264

Programme Applied: Diploma in Nursing Plan Applied: Diploma General Nursing & Midwifery (GNM)

PERSONAL DETAILS

First Name: K u m a r i

Last Name: R o o p s h i k h a

M F
Gender: Date of Birth: 1 6 0 9 1 9 9 7 Place of Birth: Jamalpur
Other

Category: Physically Challenged:

Domicile State: *As per 10th Marksheet
*Please attach Minority General SC ST OBC Other Differently Abled BR
*As per 10th Marksheet
Certificate, if any Y N

Religion: Hindu Muslim Sikh Christian Jain Buddhist Parsee Other Nationality: Indian

Father’s Name: Brajesh Kumar Mother’s Name: Indu Kumari

Father’s Qualification: Intermediate Mother’s Qualification: Intermediate

Father’s Occupation: Railway Employee Mother’s Occupation: House wife

Household Income (Per Annum): Less than `1,00,000 `1,00,001-3,00,000 `3,00,001-5,00,000 `5,00,001-8,00,000 Above `8,00,000

Aadhaar No.: 8 3 1 1 2 9 4 6 4 0 9 8 Pan Card No:

ID Proof:
Passport: Any Other:

Permanent Address (As mentioned in ID):

Qr. No. - 740/A Daulatpur Railway colony, Jamalpur

City: MUNGER

State: Bihar Pin Code: 811214

Landline No: Student Mobile No: 7 9 0 3 5 0 2 0 0 4 Parent's Mobile No: 9 4 7 1 8 5 5 5 3 0

Email (Student): roopshikha79@gmail.com Email (Parent): brajesh24486@gmail.com

Online/Internet Newspaper TV Radio Hoarding Walk-in Education Fair

Source of Information:
University Students Friends/Relatives Consultant Others

EDUCATIONAL QUALIFICATIONS

Examination Passed Year of Passing Board/University School/College Name City State Mark Scheme %(Agg.)

Xth Standard 2014 Central Board of Secondary Education Saraswati Vidya Mandir Jamalpur Bihar CGPA 6

XIIth Standard 2016 Bihar School Examination Board Sundarvati mahila college Bhagalpur Bihar PERCENTAGE 58

Graduation 2019 Tilka Manjhi Bhagalpur University Sundarvati Mahila College Bhagalpur Bihar PERCENTAGE 54

Other

Post Graduation

Name of the Degree:

Graduation Other Post Graduation

Bachelor of Commerce (Hon.s)

Details of Marks: ( Marks Obtained (MO))

PCM (in %) PCB (in %) PCSM (in %) School No. Centre No. Roll No. ID Card No.

ENTRANCE EXAMINATION DETAILS:

JEE Rank (AIR) UPSEE Rank (Gen.) UPSEE Rank (Biotech)

MAT (Percentile) CAT (Percentile) XAT (Percentile)

NATA (Score) CLAT (Score) LSAT (Score)

NEET (Score) SUAT (Score) Gate

SLET MPHIL NET

Any other

Does any of your sibling(s) studies at any of the Sharda Group of Institutions? Yes No If yes, please give details:

Name Relationship Programme System ID Year of Admission

DECLARATION BY STUDENT & PARENT

I Brajesh Kumar Parent/Guardian, of Kumari Roopshikha do hereby declare that the information given above is true and correct. I stand guarantee for good conduct of my ward during the period
of his/her study in the University/Hostel. I am aware that the University is authorised to initiate disciplinary action against my ward for violation of any of the rules and regulation/code of conduct
which is available on the University’s website (www.sharda.ac.in). I also promise to compensate fully the damages that may be caused by my ward due to his/her misconduct. I also promise to pay
the fee on time as per the instructions issued by the University from time-to-time, failing which an appropriate penalty may be.

04-08-2021 MUNGER

DATE PLACE Signature of Student

DOCUMENTS CHECKLIST

Documents Certificate/Roll No.

Application Form with a photograph affixed Yes

Photocopy of 10th Marksheet Yes

Photocopy of 12th Marksheet/Admit Card Yes

Photocopy of Diploma Marksheet No

Photocopy of Graduation Marksheet Yes

Photocopy of Other Marksheet No

Photocopy of Post Graduation Marksheet No

Photocopy of Entrance Exam Scorecard No

ID Proof Yes

Category Support Documents (Other Than General) No

Physically Challenged Certificate (If Any) No

PDFCROWD.COM