Government of Tamil Nadu

Medical Services Recruitment Board (MRB)

Application for the post of PHARMACIST

Application No
111000
Personal Information
Name : PONVANNAN P
Gender : MALE Nationality : INDIAN
Marital Status : UNMARRIED Nativie State : TAMIL NADU
Mother Tongue : TAMIL Native District : TIRUCHIRAPALLI
Aadhar : 7444 6026 7185 Place of Birth : KEELAERUTHIGOUNDANPATTI
Number
Pan Number : DDMPP4310Q Religion : HINDU
Father's Name : PALANISAMY Mother's Name : PALANIYAMMAL
Mobile : 8489550892 Email : ponvannan5270@gmail.com
Date of Birth : 09-May-1998 Age as on : 24 years, 1 month 23 days
01.07.2022

Exam Centre :
Center for Examination : 04-COIMBATORE

Community Certificate Details

Community : SC Sub Caste : Adi-Dravida-41
Issue District : TIRUCHIRAPALLI Issue Taluk : MANAPPARAI Cert. No : 7097020
Date of Issue : 07-Jun-2013 Issuing Authority : Tahsildar

Special Category Details

Are you an Ex-Servicemen : NO

Are you eligible for reservation for the differently abled persons as per the Annexure (2) of the Notification. : NO

Service Particulars
Are you a Government Servant : NO
Educational Details
Whether
Total Total
Year of Percentage studied Tamil
Qualification Maximum Obtained
Passing of Marks as one of the
Marks Marks
subject
SSLC 2013 500 398 79.6 YES
HSC 2015 1200 964 80.33 YES
B.Pharm 2020 5200 3131 60.21 NO

Tamil Nadu Pharmacy Council

B.Pharm Registration No. : 561520036
Registration Date : 20-Dec-2016

Address
Present Address : 16/SAMATHUVAPURAM,MANAPARAI(TK), TRICHY(DT), SAMATHUVAPURAM,
TIRUCHIRAPALLI, TAMIL NADU - 621306,

Permanent Address : 16/SAMATHUVAPURAM,MANAPARAI(TK), TRICHY(DT), SAMATHUVAPURAM,

TIRUCHIRAPALLI, TAMIL NADU - 621306,

Documents Uploaded
Photo : Uploaded SSlc mark sheet : Uploaded
Signature : Uploaded HSC mark sheets : Uploaded
Community Certificate : Uploaded B.Pharm Mark Sheet : Uploaded
B.Pharm certificate : Uploaded
:

Payment Details
Mode of Payment Payment Status Amount Paid Transaction No Transaction Date
ONLINE SUCCESS 300 2203150922 30.08.2022 10:49AM

Declaration
I. I hereby declare that the particulars furnished by me in this application are true, correct and complete to the best of my
knowledge and belief and nothing has been concealed or suppressed. I also understand that in the event of any
information being found false or incorrect or ineligibility being detected before or after the examination or selection, I
shall be liable for action to be taken by MRB.
II. I accept the undertaking & declaration of the candidate as in para 11A & 11B of the detailed notification and declare
that I am not disqualified to apply for the post.

Name: PONVANNAN
P