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All India Institute of Medical Sciences

Ansari Nagar, New Delhi - 110608

Registration Form - Institute of National Importance Combined Entrance Test (INI-CET) for admission to PG courses [MD/MS/M.Ch.(6years)/DM(6years)/MDS]
JANUARY 2021 Session

Candidate Profile Registration ID: P6161418080 Payment ID: 30060167 Registration Unique Code: 7175352

Candidate Name: KATUKOJWALA MOUNIKA Applied Course: MD/MS/MCH(6YRS)/DM(6YRS)

Date of Birth: 23 Nov 1994 Category: OBC (NCL)

Gender: Female Marital Status: Unmarried

Father's Name: KATUKOJWALA MANOHAR Mother's Name: KATUKOJWALA MANOHAR

PWBD Status: No PWBD Category: NA

Nationality: INDIAN Applied Under: General

Identification Mark(1): A MOLE ON THE LEFT HAND MIDDLE FINGER Identification Mark(2):
A MOLE ON THE RIGHT HAND RING FNGER

Certificate Issue Date: 01/01/1900

Are you currently pursuing PG Course in any Subject: NO Do you belong to Karnataka Domicile Category:
NO

Do you belong to North East Domicile Category: NO

Service in Armed Forces (as per note 3 of Appendix-E)?: NA Service in Central/State Govt. of 3 years or more
(as per note 3 of Appendix-E)? : NA

Contact Details

Address for Permanent: Correspondence Address:

H.NO 6-213, SAIMOUNIKA JEWELLERY , NEAR AMBEDKAR STATUE , MAIN H.NO 6-213, SAIMOUNIKA JEWELLERY , NEAR AMBEDKAR STATUE , MAIN
ROAD , BHUPALPALLY, JAYASHENKAR DISTRICT, Bhupalapalli , Warangal, ROAD , BHUPALPALLY, JAYASHENKAR DISTRICT, Bhupalapalli , Warangal,
TELANGANA, India, 506169 TELANGANA, India, 506169

Mobile No: 1. 8688414619 , 2. Alternate-MobileNo 0 E-Mail ID: katukojwalamounika@gmail.com

Qualification Details

Qualifying Examination Degree From State Name Admission Date Passing Date

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MBBS Indian University Telangana 03/09/2014 23/03/2019

University Name Institute/College Name

NTRUHS Prathima Institute of Medical Sciences, Karimnagar

Academic Details

Qualifying Exam Max Marks Marks Obtained Percentage(%)

MBBS 2450.00 1581.00 64.53

Internship Details

Internship Status Internship Start Date Completion/Expected Completion Date No. of Days
Completed 23/03/2019 23/03/2020 367

Medical Registration Details

Registration Type Registration Date Registration Number Registering Authority

Provisional 20/05/2019 TSMC/PMR/08445 State Council -- (Telangana )

Valid Photo Identity (To be presented in original at the Examination Center along with Admit Card)

ID Proof: Adhar Card ID No: 835419959461 Place of Issue: India Issue Date: NA Valid Till: NA

Do you have experience : No

Payment Details

Mode: Online Date: 18/10/2020 Transaction ID: 7141808068 Amount: 2000

Examination City Opted:

State: Exam City(Preference 1): State : Exam City(Preference 2): State : Exam City(Preference 3):

Telangana Warangal Telangana Karimnagar Telangana HYDERABAD/SECUNDERABAD/RANGA REDDY

UNDERTAKING/DECLARATION: I hereby declare that the information furnished by me in the Registration/Application Form is correct and nothing has been
concealed. In case any information furnished by me is found to be false/incorrect/untrue than i shall be liable to civil/criminal prosecution and my claim to
admission/appointment/registration/ service in the Institute may be cancelled/terminated.

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Signature of Candidate
Thumb of Candidate

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