Common Nursing Entrance Test (CNET) 2023

[Link]. Nursing (4 Years) APPLICATION FORM (FINAL PRINT)

Registration Id No. : 123007031
Application Id 58002250 Application Date 2023-04-20 15:24:09

Transaction Id 112856402485 Transaction Date 19-04-2023 12:14:54 pm

Bank Reference No. 121452 Paid Amount 3000.00

PERSONAL DETAILS

Name SHRADDHA VERMA Father/Husband Name MAHENDRA PRATAP SINGH

Mother Name GOLDI VERMA Gender FEMALE

Date of Birth 07/11/2006 Age on (December, 31, 2023) 17 YEARS, 1 MONTH, AND 24 DAYS
OLD.

Place of Birth MOHAMMDI ROAD SARAYAN Nationality INDIAN

NADI GOLA DEHAT

Mobile No. 9454236144 Email MAHENDRASINGHSR88@[Link]

Category OBC (OTHER BACKWARD Sub-Category NA

CLASSES)

Address of Correspondence

Permanent Address

House No./ Street / Village 01 MOHAMMDI ROAD SARAYAN Mohalla / Area / Post Office GOLA GOKARAN NATH
NADI GOLA DEHAT GOLA
GOKARAN NATH KHERI

City SHAHJAHANPUR State UTTAR PRADESH

Pincode 262802

Full Address for Correspondence

House No./ Street / Village 01 MOHAMMDI ROAD SARAYAN Mohalla / Area / Post Office GOLA GOKARAN NATH
NADI GOLA DEHAT GOLA
GOKARAN NATH KHERI

City SHAHJAHANPUR State UTTAR PRADESH

Pincode 262802

Academic Qualifications

Passing Max. Obtained % of

Examination Passed Board / University Institute / College Year Marks Marks Marks Subjects

High School UTTAR PRADESH STATE S V M I C GOLA 2020 600 443 73.83 HINDI
BOARD OF HIGH LAKHIMPUR KHERI ENGLISH
SCHOOL AND MATH
INTERMEDIATE SCIENCE S
EDUCATION SCIENCE
DRAWING

Intermediate UTTAR PRADESH STATE K S I C GOLA 2022 500 253 50.60 GEN HINDI
BOARD OF HIGH LAKHIMPUR KHERI ENGLISH
SCHOOL AND PHYSICS
INTERMEDIATE CHAMISTRY
EDUCATION BIOLOGY

Examination Maximum Marks Obtained marks Examination Maximum Marks Obtained marks

Biology 100 78 Physics 100 57

Chemistry 100 74 English 100 69

Exam City Preference

Preference 1 : Bareilly Preference 2 : Lucknow Preference 3 : Kanpur

Bank Account Details for Refund

Account No. as per Bank 6804001700073200 Name as per Bank SHRADDHA IFSC Code as per Bank PUNB0190100
Record : Record : VERMA Record :

Name of Bank : PUNJAB NATIONAL State : UTTAR PRADESH District : KHERI

BANK

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)