sito, 146 PM \IPMER PUDUCHERRY JAWAHARLAL INSTITUTE OF POST-GRADUATE MEDICAL EDUCATION & RESEARCH as (An Initution of National Importance Under Ministry of Health & Family Welfare, Government of India) NOTE four application has been successfully submitted. Your Payment is successful Post Applied Details Post Apply 112022 - Nursing Officer Have you applied for any other Nursing Council Registration No once) 226112 No Personal Details Application Sequence No 19997 Applicant Name THARANID Son/Daughter of DURAIT Gende Are you a Resident Indian National Female Yes Date of Birth (ddzmm/yyy9) Age as on 30.03.2022 25/Jan/1999 23 Years 2 Months 5 Days Category Details hitpsshwodiglakm.comFarms!PayUAlerPaymentActon do?74485ZZ8272ZZoninesito, 1146 PM nchmark Disab Eligible Category Other Backward Class (OBC - Non Creamy Layer) \IPMER PUDUCHERRY Other Backward Class (OBC - Non Creamy Layer) you an Exserviceman? Whether employed in Central Govern No Name of Board/Institute/University 10th Details Class ‘Year Appeared 10th/SSLC 03/2014 Name of Board/insttute/Universty Place of Su State board Tamil Nadu Karaikal 12th/HSC/Diploma Details class Vear Anpea 12th/HSC 03/2016 Place of Study any State Nursing Cou Serial Number of your ‘Essential Qualficat’on’ 1 State board Tamil Nadu Karaikal Essential Qualification Serial Number Essential Qualification 1 () Degree OR Diploma in General Nursing and Midwifery or equivalent from a recognized University/Institu (i) Registered as Nurse and Midwife under Indian Nursing council Act 1947/ cil htpsshww gia com Forms!PayUAMtorPaymantAction do?744852Z8272Z0r 28sito, 146 PM Work Experience Details \IPMER PUDUCHERRY Sr. No. Form Date To Date 1 01/09/2020 10/03/2022 2 05/11/2019 22/08/2020 Total Work Experience 2 Year(s), 3 Month(s)26 Day(s) Total Experience 1 Year(s) 6 Monthis)9 Day(s) 0 Year(s) 9 Month(s)17 Day(s) Present Address Details Address Line 1 No. 2/22, Raj residency Address Line 2 Kennet Lane idress Line 3 Egmore State Tamil Nadu Pin Code 600008, Confirm Mobile Number 9025470738 Confirm Email Address dtharani99@gmail.com iy Chennai Mobile Numoe 9025470738 Emall Address dtharani99@gmail.com Is Permanent Address same No resent Address? Permanent Address Address Line 1 No.12, North street Address Line 2 Kakamozhi hitpsshwodiglakm.comFarms!PayUAlerPaymentActon do?74485ZZ8272ZZonine 38sito, 1146 PM Address Line 3 Neravy State Puducherry Pin Code 609604 Confirm Mob 9025470738 le Number Confirm Email Address dtharani99@gmail.com \IPMER PUDUCHERRY City Karaikal Mobile Numeer 9025470738 Email Address dtharani99@gmail.com ID Proof Details Preferred Test City Option 3 Vellore 1D Proof 1D Proof no VOTER ID NPx0091249 Exam City Preference Preferred Test City Option 1 Preferred Test City Option 2 Chennai Puducherry Payment Details ‘Amount 1500 Payment Status Successful Payment Mode online Payment Transaction No. 14834533922 Candidate Documents/Images Upload Details hitpsshwodiglakm.comFarms!PayUAlerPaymentActon do?74485ZZ8272ZZonine 48sito, 11:46 pM \IPMER PUDUCHERRY Photo. Signature Declaration I hereby declare that | have carefully read the Advertisement and the Non Disclosure agreement. hereby declare that | am an Indian National. | understand that fees once paid will not be refunded under any circumstances hereby declare that the information given above is true and correct to the best of my knowledge and belief further declare to produce all certificates in original at the time of Certificate Verification / Appointment relevant to my claims made in the application. | also agree to forfeit my claim for Appointment in the event of failure to produce the relevant original certificates I shall abide by the actions and decisions taken by the Jawaharlal institute of Postgraduate Medical Education & Research Version 14.03.01 hitpshwodiglakn.comFarms!PayUAllerPaymentActon.do?74485ZZ8272ZZonine