22/05/2023, 21:37 Online Application Printing

MAHARASHTRA STATE BOARD OF NURSING AND PARAMEDICAL EDUCATION

Directorate of Medical Education & Research, 4th Floor, St. George’s Hospital Compound,
P. D’Melo Road, Near C.S.M.T., Mumbai – 400 001
Print Date : 22/05/2023

Application For Diploma of Examination

The Registrar,

MAHARASHTRA STATE BOARD OF NURSING AND PARAMEDICAL EDUCATION

Directorate of Medical Education & Research, 4th Floor, St. George’s Hospital
Compound,
P. D’Melo Road, Near C.S.M.T., Mumbai – 400 001
MUMBAI 400001

Sir/Madam,

I request you to register my name and other particulars as stated below in part.
Section of the register maintained under Maharashtra Nurse's Act, 1966 and further to give me a certificate of
registartion.

Application Info
Application Application Application
: 20230009623 : 19-05-2023 :
No. Date Type Diploma Examination Certificate

PersonalInfo Details
Prefix : Miss. First Name : Sakshi
Middle Name : Gajanan SurName : Chavan
Mother Name : Sushila Marrital Status : Single
Gender : Female Nationality : Indian
Caste : S.C Religion : Buddhists

BirthInfo Details
Date of Birth(dd/MM/yyyy) : 20-08-2001 Place Of Birth State : MAHARASHTRA
Place Of Birth District : Akola Place Of Birth Taluka : Akola
Place of Birth : akola

PresentAddress Details
Anand Nagar Hingna Road Near Bholenath
Address : State : MAHARASHTRA
Mandir Akola Akola Maharashtra 444004
District : Akola Taluka : Akola
Pin Code : 444000

Permanent Address Details

Anand Nagar Hingna Road Near Bholenath
Address : State : MAHARASHTRA
Mandir Akola Akola Maharashtra 444004
District : Akola Taluka : Akola
Pincode : 444000

Additional Details
Email ID : sudhirdhone@gmail.com Mobile No : 9422163910
Telephone : Alternate Mobile No. :
Aadhar Card No : Passport No :

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Educational Details
AUXILLARY NURSE Date of obtaining
Qualification : : 30-10-2021
MIDWIFERY Qualification

PreEducation Qualification Details

Sr. No. Qualification Passing month Passing Year Board Total Marks Out Of Marks
1 S.S.C MARCH 2017 MAHARASHTRA STATE BOARD 274 500
2 H.S.C FEBRUARY 2019 MAHARASHTRA STATE BOARD 399 650

Course Details
Institute From where DR. VANDANTAI DHONE NURSING SCHOOL,
: Region : Nagpur
Appeared For Exam AKOLA
Maharashtra State Board of Nursing and
University : Grade : First Division
Paramedical Education
Exam held in the month : OCTOBER Exam held in the Year : 2021
Theory Exam Passed
Seat No. : 5905 Marks : 476
(GNM/ANM/B.Sc.)
Out Of : 500

Sr.
Institute Name Period From Period To
No.

1 DR. VANDANTAI DHONE NURSING SCHOOL, AKOLA 01/08/2019 30/10/2021

Amount For this Application

Total Amount : 750.00

Date :

Signature of the Applicant

Print Back

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