4/24/25, 10:25 AM

Common Nursing Entrance Test (CNET) 2025

[Link]. Nursing (4 Years) APPLICATION FORM (FINAL PRINT )
Registration Id No. : 125043367

Application Id 58030710 Application Date 24-04-2025 10:06:39

Transaction Id pay_QMll3mnlH6P2ls Transaction Date 2025-04-24 10:22:21
Bank Reference No. order_QMlin6dPs0znKY Paid Amount 3000

Personal Details
Name ANUSHKA SINGH Father Name ANIL KUMAR SINGH
Mother Name REENA SINGH Gender FEMALE
Date of Birth 15/02/2007 Age on (December, 31, 2025) 18 YEARS, 10 MONTHS & 16 DAYS.
Mobile No. 8810808825 Alternate Mobile No. 7007749489
WhatsApp Mobile No. 8810808825 Email AS7.ANUSHKA7@[Link]
Aadhaar Card No. 776283392332 Are you a Domicile of Uttar-Pradesh? YES
Category GENERAL (UR - ECONOMICAL Sub-Category NA
BACKWARD CLASSES - EWS)

Address
Permanent Address
House No./ Street / Village 283/711 (063C/12) PREMWATI NAGAR Mohalla / Area / Post Office GARHI KANAURA MANAKNAGAR
City LUCKNOW State UTTAR PRADESH
Pincode 226011
Full Address for Correspondence
House No./ Street / Village 283/711 (063C/12) PREMWATI NAGAR Mohalla / Area / Post Office GARHI KANAURA MANAKNAGAR
City LUCKNOW State UTTAR PRADESH
Pincode 226011

Academic Qualifications
Passing Max. Obtained
Examination Passed Board / University Institute / College Year Marks Marks % of Marks Subjects
High School CBSE BAL VIDYA MANDIR 2023 600 455 75.83 ENGLISH LNG
STATION RD CHARBAGH LIT, HINDI
LUCKNOW UP COURSE A,
MATHEMATICS
STANDARD,
SCIENCE,
SOCIAL
SCIENCE,
INFORMATION
TECHNOLOGY
Subject Maximum Marks Obtained marks Subject Maximum Marks Obtained marks
Science 100 66 Mathematics / Other 100 56
Social Science 100 75 English 100 85
Hindi / Other Language 100 87

Intermediate Appearing CBSE BAL VIDYA MANDIR 2025 - - - ENGLISH,

STATION RD CHARBAGH PHYSICS,
LUCKNOW UP CHEMISTRY,
BIOLOGY,
PHYSICAL
EDUCATION

1/3
4/24/25, 10:25 AM

Academic Qualifications
Passing Max. Obtained
Examination Passed Board / University Institute / College Year Marks Marks % of Marks Subjects
Subject Maximum Marks Obtained marks Subject Maximum Marks Obtained marks
Biology - - Physics - -
Chemistry - - English - -

Exam City Preference

Preference 1 : LUCKNOW Preference 2 : KANPUR Preference 3 : GONDA

Bank Account Details for Refund

Account No. as per Bank 97088100000148 Name as per Bank ANIL KUMAR IFSC Code as per Bank BARB0DBRLUC
Record : Record : SINGH Record :
Name of Bank : BANK OF State : UTTAR PRADESH District : LUCKNOW
BARODA

2/3
4/24/25, 10:25 AM

Common Nursing Entrance Test (CNET) 2025

[Link]. Nursing (4 Years) APPLICATION FORM (FINAL PRINT)
Registration Id No. : 125043367

PASSPORT SIZE PHOTO & LIVE PHOTO

VERIFICATION PROFORMA

PASSBOOK FRONT / CANCELLED CHEQUE PHOTO

DECLARATION
I hereby declare that the particulars given in this application form are correct. if any relevant information is found to be concealed or incorrect
my candidature/ admission may be cancelled.

(Candidate Signature)

3/3