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Application Form

The document contains the application details of Amrita M Nambiar for the B.Sc. Nursing program, including personal information, contact details, and payment information. It confirms her eligibility and agreement to the admissions process, stating that all provided information is accurate. Additionally, it outlines the consequences of providing false information and specifies the jurisdiction for any disputes.

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amritamnambiar
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3 views1 page

Application Form

The document contains the application details of Amrita M Nambiar for the B.Sc. Nursing program, including personal information, contact details, and payment information. It confirms her eligibility and agreement to the admissions process, stating that all provided information is accurate. Additionally, it outlines the consequences of providing false information and specifies the jurisdiction for any disputes.

Uploaded by

amritamnambiar
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

APPLICANT DETAILS

Name AMRITA M NAMBIAR Application Number 126155195

Email ID nambiaramrita492@[Link] Mobile Number +918590341170

Gender Female Date of Birth 10/04/2007 Nationality Indian

CATEGORY DETAILS

Category General Sub Category General

PROGRAM DETAILS

Program Level Undergraduation - UG Stream Nursing

Course [Link]. Nursing

Tentative Test Location 1 Kerala - Kannur Tentative Test Location 2 Kerala - Kozhikode Tentative Test Location 3 Kerala - Ernakulam

Specialization Preference 1 [Link]. (Nursing - UNB),Manipal Specialization Preference 2 [Link]. (Nursing),Manipal

PARENT OR GUARDIAN DETAILS FOR COMMUNICATION

Full Name MAHESH KUMAR PAYYAN KELOTH

Email mpkandoor@[Link] Mobile Number 918075056887

ADDRESS DETAILS

Address
Address Type Address 1 City State Country Pincode
2

Correspondence PAYYAN KELOTH HOUSE, ANDOOR,


Dharmasala Kerala India 670563
Address PARASSINIKADAVU(PO) , 670563(PIN)

PAYYAN KELOTH HOUSE, ANDOOR,


Permanent Address Dharmasala Kerala India 670563
PARASSINIKADAVU(PO) , 670563(PIN)

PAYMENT DETAILS

Transaction Id 114263997331 Date 30/01/2026 Amount INR 2000.00

DECLARATION

• I hereby confirm that the above-mentioned details are correct. I declare that all the
particulars stated in this application form are true to the best of my knowledge and belief. I
have read and understood all provisions of the admissions process and agree to abide by them. I
also affirm that I fulfill the eligibility requirements for the program(s) applied. I
understand that I can only apply once for each group. In case I apply more than once, only
one of my applications will be accepted, and the application and entrance test fees remitted
will not be refunded.
• If it is found at a later stage, during active verification, that I have provided false, incorrect
or untrue information w.r.t educational qualifications, marks, nationality, etc., or submitted an
eligibility document from an unrecognized board or university, my admission or degree will
be canceled without notice, with forfeiture of all fees paid.
• Jurisdiction for disputes, if any, shall be at the Udupi Court, Karnataka, India only.

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