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id=2yLkbmHqFtC1KLaUjQIeBPEYntFtD2NGALUVpgtXfbSreeO3…

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]
Jan 2023 Session

Candidate Profile Registration ID: P6151355099 Payment ID: 30039436 Examination Unique Code: 9134744

Candidate Name: RANJEET KUMAR GHRITLAHARE Applied Course: MD/MS/MCH(6YRS)/DM(6YRS)

Date of Birth: 04 Jul 1988 Category: SC

Gender: Male Marital Status: Unmarried

Father's Name: BEDRAM GHRITLAHARE Mother's Name:

SHAILENDRI DEVI GHRITLAHARE

PWBD Status: No PWBD Category: NA

Nationality: INDIAN Applied Under: Indian National

Identification Mark(1): MOLE ON RIGHT LOWER LIP Identification Mark(2): MOLE ON RIGHT CHICK

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: YES Do you want to apply for Bhutani National
Candidate : NA

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

Applied for PGIMER,Chandigarh under Sponsored Category (Indian National)?: NA Applied for JIPMER,Puducherry under
Sponsored Category (Indian National)? : NA

Applied for AIIMS(Delhi/Rishikesh) and SCTIMST, Trivandrum under Sponsored Do you want to apply for NIMHANS,Bengaluru
Category (Indian National)?: NA under Sponsored Category(Indian National) : NA

Contact Details

Address for Permanent: Correspondence Address:

WARD NO 19 , KODABHAT PAMGARH , DISTT JANJGIR CHAMPA , Kodabhat , CIMS BOYS HOATEL, BILASPUR , BILASPUR , Gole Bazar Bilaspur ,
Janjgir-champa, CHATTISGARH, India, 495554 Bilaspur(CGH), CHATTISGARH, India, 495001

Mobile No: 1. 9589338444 , 2. No E-Mail ID: rnjtlahare07@gmail.com

Qualification Details

Qualifying Examination Degree From State Name Admission Date Passing Date

MBBS Indian University Chhattisgarh 28/09/2011 22/03/2018

University Name Institute/College Name

PT.D.D.U.MEMO.H.S.AND AYUSH UNIVERSITY OF RAIPUR (C.G.) Chhatisgarh Institute of Medical Sciences, Billaspur,

Academic Details

Qualifying Exam Max Marks Marks Obtained Percentage(%)

MBBS 2450.00 1366.00 55.76

Internship Details

Internship Status Internship Start Date Completion/Expected Completion Date No. of Days
Completed 31/03/2018 30/03/2019 365

Medical Registration Details

Registration Type Registration Date Registration Number Registering Authority

Permanent 05/11/2019 CGMC9429/2019 State Council -- (Chhattisgarh )

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

ID Proof: PAN Card ID No: CHQPG779H Place of Issue: INDIA Issue Date: NA Valid Till: NA

Do you have experience : No

Payment Details

Mode: Online Date: 18/10/2022 Transaction ID: 13550992617 Amount: 3200

Examination City Opted:

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State: Exam City(Preference State : Exam City(Preference State : Exam City(Preference Exam City(Preference
1): 2): 3): 4):

CHHATTISGARH RAIPUR CHHATTISGARH BHILAI NAGAR ANDHRA VISAKHAPATNAM Any Other City
PRADESH

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.

Signature of Candidate
Thumb of Candidate

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