KARNATAKA STATE DIPLOMA IN NURSING EXAMINATION BOARD
(1st Floor Library Block, Bangalore Medical College & Research Institute Campus,Bengaluru-560 002.
Ph: 080-26700074,75, Website: [Link]/net), Email ID: ksdneb@[Link]
MAY-2023 Practical Examination Remuneration Details (INDIVIDUAL EXAMINER FORM)
Name of the Examiner_______________________________________ Designation:_______________________ Institution:_________________________________________________
Sl. School Name of the Number of Students attended the practicals Total Conveyance Total
No. Code Institution & Place No. of No. of days Amount
Students x x Rs. 375/-
Rs.50
IstYr IInd Yr IInd Yr IInd Yr IIIrd Yr IIIrd Yr IIIrd Yr
Pra-I Pra-I Pra-II Pra-3 Pra-I Paediatric Pra-II
FON MSN-I Child Mental Midwifery CHN-2
Health Health
01
02
03
04
05
06
07
Name & Signature of the Pra Co-Ordinator:__________________ _______________ __ Institution:__________________________________________ Sch Code:____________
The above Practical Internal & External Examiner has actually conducted practical to the student as claimed in the statement.
Bank Details of Examiner:
A/c No. of Examiner Name of the Bank & Branch IFSC Code Mobile No. Email ID
KARNATAKA STATE DIPLOMA IN NURSING EXAMINATION BOARD
(1st Floor Library Block, Bangalore Medical College & Research Institute Campus, Bengaluru-02, Ph: 080-26700074, 26700075
Website: [Link] , E-mail: ksdneb@[Link] )
Statement of Payment for MAY-2023 Practical Examination Remuneration & Conveyance Charges
Name of the Practical centre: __________________________________________ School Code
Name of the Institution for which practical
examination conducted:- _____________________________________________________________________________________________________________
Sl. Name of the Examiners, Designation Remuneration Conveyance Charges Total
No. Practicals & Name of the School (for local Examiners only) (3 + 4) Signature
No. of days Rs.
No. of Student x Rs 50 x Rs. 375 Per day Total Amount has to be
(3) (6)
(4) entered
(1) (2) (5)
1 I Year Int:
Practical – I x 50 = x 375 =
Fundamentals of School Name:
Nursing Ext:
x 50 = x 375 =
School Name:
2 II Year Int:
(New Syllabus) x 50 = x 375 =
Practical-I School Name:
Medical Surgical Ext:
Nursing, x 50 = x 375 =
School Name:
3 II Year Int:
(New Syllabus) x 50 = x 375 =
School Name:
Practical-II
Ext:
Child Health
Nursing
x 50 = x 375 =
School Name:
4 III Year Int:
Practical-I x 50 = x 375 =
Midwifery & School Name:
Gynaecology Ext:
x 50 = x 375 =
School Name:
KARNATAKA STATE DIPLOMA IN NURSING EXAMINATION BOARD
(1st Floor Library Block, Bangalore Medical College & Research Institute Campus, Bengaluru-02, Ph: 080-26700074, 26700075
Website: [Link] , E-mail: ksdneb@[Link] )
Statement of Payment for MAY-2023 Practical Examination Remuneration & Conveyance Charges
Name of the Practical centre: __________________________________________ School Code
Name of the Institution for which practical examination conducted:- ____________________________________________________________________
Sl. Name of the Examiners, Designation Remuneration Conveyance Charges Total
No. Practicals & Name of the School (for local Examiners only) (3 + 4) Signature
No. of Student x Rs 50 No. of days Rs.
(3) x Rs. 375 Per day (5) (6)
(1) (2) (4)
III Year Int:
5 x 50 = x 375 =
School Name:
Practical
Paediatric Nursing Ext:
x 50 = x 375 =
School Name:
6 III Year Int:
x 50 = x 375 =
Practical – II School Name:
Community Health Ext:
x 50 = x 375 =
Nursing-II School Name:
7 Computer Operator
for Uploading Rs. 500/- (Fixed Amount per centre) Rs. 500/-
Practical Marks
Practical Coordinator
8.
(Rs. 1000/- Fixed amount)
Rs. 1000/-
Total
I have disbursed the total amount of Rs. ……………………………… (in words) Rs. ………………………………………………………………………………………………………………………………………………….
to the above said officials as noted against their names towards remuneration and Conveyance charges for MAY-2023 Practical Examination.
Co-Ordinator Name Name of the School A/c No. Name of the Bank & Branch IFSC Code
Office Use Only
The payment made is accepted Voucher No.: ………………… Date……………… Signature of the Secretary
KSDNEB, Bengaluru
