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PGIMER Application Form

Uploaded by

Umar Wani
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© © All Rights Reserved
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0% found this document useful (0 votes)
45 views5 pages

PGIMER Application Form

Uploaded by

Umar Wani
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
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Candidate Personal Details

Application Status Application Number Candidate First


PaymentSuccess 997005399 Name
UMMAR
Candidate Middle Candidate Last
Name Name
FAROOQ WANI
Date of Birth Gender Have you ever
07/Mar/2000 Male changed your
name?
No
Marital Status Religion Father's Name
Unmarried Muslim FAROOQ AHMAD
WANI
Father's Age Father's Occupation Father's Gross
68 RETIRED Monthly Income
28000
Mother's Name Mother's Age Mother's
SHAKEELA BEIGIM 58 Occupation
HOUSEWIFE
Mother's Gross Email ID Mobile Number
Monthly Income ummarwani25@gmail 9682325681
0 .com Alternate Mobile
Number
7889420626

Post Details

Post Name Post Code Advertisement


Nursing Officer NUR/001 Number
PGI/RC/048/2025/570
6
Advertisement Date Institute Choice1
03/07/2025 PGIMER Satellite
centre, Sangrur

Candidate Domicile and Category Details

Nationality Applying Category Candidate Category


Indian UR UR

Additional Details

Are you an Ex
Servicemen (ESM)?
No
Are you PwBD i.e. Are you an Are you Permanent
Person with employee of Central Employees of
Benchmark Govt? current
Disabilities with at No organization?
least 40% disability? No
No

Identification Details

Please select type of Pan Card Number : Name on Pan Card:


Identification 787L UMMAR FAROOQ
Pan Card WANI

Correspondence Address

Address Line 1 Address Line 2 Country


SOGAM WANI SOGAM LOLAB India
MOHALLA LOLAB KUPWARA State
KUPWARA
Jammu and Kashmir
City/District Pincode/Postal Code Is Permanent
Kupwara 193223 Address Same as
Correspondence
address?
Yes

Permanent Address

Address Line 1 Address Line 2 Country


SOGAM WANI SOGAM LOLAB India
MOHALLA LOLAB KUPWARA
State
KUPWARA
Jammu and Kashmir
City/District Pincode/Postal Code
Kupwara 193223

Matriculation (10th) Details

Name of the Board School/ lnstitute Percentage of


Jammu and Kashmir Name Marks/CGPA/Grade
State Board Of School Boys higher Percentage
Education secondary sogam
Marks Obtained
405
Maximum Marks Percentage of Year of Completion
500 Marks (%) 2014
81.00

lntermediate (12th) Details

Name of the Board School/ lnstitute Subjects


Jk BOSE Name SCIENCE STREAM PCB
Boys higher Percentage of
secondary sogam
Marks/CGPA/Grade
lolab
Percentage
Marks Obtained Maximum Marks
439 500 Percentage of
Marks
87.80
Year of Passing
2016

Graduation Details

Qualification Institute passed Subjects


Degree from Nursing Subjects
Regular course in Desh Bhagat Month and Year of
B.Sc. Nursing University Mandi Passing
Gobindgarh
Fatehgarh Punjab 27/11/2022
Percentage of
Marks/CGPA/Grade
Percentage
Marks Obtained Maximum Marks Percentage of
1864 2800 Marks
66.57

Nursing Council Registration Details

Nursing Council RN Number RM Number


Registration Date 5965 5965
19/10/2023 Name of the State of Nursing
Nursing Council council
Jammu and Kashmir Jammu and Kashmir
Nursing Council Date of Registration
19/10/2023
Registration validity
till date
19/10/2028

Post Specific Questions

Are you Registered


as a Nurse or Nurse
and mid-wifery from
State Nursing
Council?
Yes

Test City Preferences

Preferred Test State Preferred Test City 1 Preferred Test State


1 CHANDIGARH/MOHA 2
Chandigarh LI New Delhi
Preferred Test City 2 Preferred Test State Preferred Test City 3
DELHI/NCR 3 HYDERABAD
Telangana

Payment Details
Amount Payment Mode Payment Status
1500 online Payment Success
Payment
Transaction No.
4569729424519

Documents Upload

Candidate Photo Signature


Document View / Download
To view your copy of scanned 10th class certificate: Click here.

To view your copy of scanned 12th class certificate: Click here.

To view your copy of Graduation degree certificate: Click here.

To view your copy of Other relevant documents: Click here.

Declaration

Have you been Have you ever been Have you ever been
debarred or involved in any involved in any
punished for administrative financial
adopting unfair malpractice? irregularity?
means in any No No
Examination by the Were you ever Is there any pending
Institution/Board/U discharged or or contemplated
niversity? dismissed from any disciplinary
No previous proceedings against
employment? you?
No No
Is there any
Case/FIR Lodged
against you?
No
I hereby certify that the information given by me in this Application Form is
true to the best my knowledge. I certify that I fulfill the Govt Form eligibility
criteria and undertake to produce original documents whenever necessary
and I will not demand any reschedule of exam. I agree to abide by the
declaration of the authorities regarding the eligibility of my application and
understand that any misrepresentation or omission of facts in my
application may justify cancellation of my Govt Form application & scores. I
understand that all disputes will be subject to the territorial jurisdiction of
city of Indore only.
I hereby certify that the information given by me in this Application Form is
true to the best my knowledge. I certify that I fulfill the Govt Form eligibility
criteria and undertake to produce original documents whenever necessary
and I will not demand any reschedule of exam. I agree to abide by the
declaration of the authorities regarding the eligibility of my application and
understand that any misrepresentation or omission of facts in my
application may justify cancellation of my Govt Form application & scores. I
understand that all disputes will be subject to the territorial jurisdiction of
city of Indore only.
I hereby declare that all the statements made in this application form are
true, complete and correct to the best of my knowledge & belief. In the
event of any information being found false or incorrect, or any ineligibility
being detected at any time during or after the selection process, my
candidature may be cancelled and action can be taken against me by the
Commission.
I have read the advertisement and the relevant Services Rules related to this
recruitment carefully and I hereby undertake to abide by them. I fulfil alt the
conditions of eligibility regarding age limit, educational qualifications etc.
prescribed in the advertisement and relevant Rules.
l am in possession of all the certificates / documents in support of my claim
made above in the application form.

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