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National Board of Examinations: Medical Enclave, Ansari Nagar, Mahatma Gandhi Marg (Ring Road) New Delhi-110029

1) The document is an application form for Divya Rani to take the NEET-MDS exam. 2) Divya Rani is from New Delhi, India and completed her BDS degree in 2016 from Bharti Vidyapeeth Dental College & Hospital in Sangli, India. 3) She is applying to take the NEET-MDS exam in Delhi and has paid the registration fee of 3750 rupees online.

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Sidharth Shekhar
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173 views

National Board of Examinations: Medical Enclave, Ansari Nagar, Mahatma Gandhi Marg (Ring Road) New Delhi-110029

1) The document is an application form for Divya Rani to take the NEET-MDS exam. 2) Divya Rani is from New Delhi, India and completed her BDS degree in 2016 from Bharti Vidyapeeth Dental College & Hospital in Sangli, India. 3) She is applying to take the NEET-MDS exam in Delhi and has paid the registration fee of 3750 rupees online.

Uploaded by

Sidharth Shekhar
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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NATIONAL BOARD OF EXAMINATIONS

Medical Enclave,Ansari Nagar,Mahatma Gandhi Marg(Ring Road) New Delhi-110029


Application Print Form: NEET-MDS

Candidate Profile Candidate ID: 2222004885 Registration No: 222007358 Registration Date: 01/11/2017

Candidate Name: DIVYA RANI Date of Birth: 01 Mar 1993

Gender: Female Category: General

Father's Name: LATE BIRENDRA SINGH Mother's Name: PREMSHILA SINGH

Persons with Disability Status: No Aadhaar Card No: 671144239637

Nationality: INDIAN

Marks of Identification 1: Marks of Identification 2:


Willing for short service commission in Army dental corps : Yes

Armed forces Medical Services (Type): Civilian Doctor

Willing to take up post graduate courses in Place Of Birth : Jharkhand


institution/hospital of Armed Forces Dental Services : Yes

Minority: Religious Religious: HINDU

Contact Details

Address for Permanent: Correspondence Address:


C O RAILWAY BOOKSTALL, MURI, P S CHOTA MURI, Ranchi, Jharkhand, India, ROOM NO 102, SURIS 135/5 OPP PEEPAL HANUMAN MANDIR, GAUTAM
835101 NAGAR, New Delhi, Delhi (NCT), India, 110049

Mobile No: 1. 9711613900 , 2. Alternate-MobileNo 7004878230 E-Mail ID: [email protected]

Qualification Details

Qualifying Exam BDS Degree From Indian University College Name Bharti Vidyapeeth Dental College & Hospital, Sangli

University Name: BHARTI VIDHYAPEETH Date of Admission: 22 May 2012 Date of Passing: 28 May 2016

Acedemic Details

Marks obtained 1016 Max Marks 1600 Percentage(%) 63.5

InternShip Details

Internship Status: Completed InternShip start Date 1/7/2016 Completion Date 2/7/2017 No. Of Days 367

Medical Registration Details

Registration Type: Permanent Registration Date: 11/9/2017 Registration Number: a423

Dental Council: Jharkhand Dental Council

Other Qualification Details

State from where you have done your class XTH Jharkhand State from where you have done your class XII Jharkhand

You ever been deported/rusticated during BDS Course No Details of deportation/rustication N/A

Charged of using unfair means by NBE No Details for being charged N/A

Appearance in any recent exam conducted by NBE No Most Recent Prevoius Exam in which appereared in N/A

Prevoius Roll Number Or Testing ID og Most Recent Exam N/A Year of Most Recent Exam N/A

Valid Photo Identity (To be presented in original at the Examination Center along with Admit Card)

ID Proof: Aadhar Card ID No: 671144239637 Place of Issue: INDIA Issue Date: NA Valid Till: NA

Payment Details

Mode: Online Date: 02/11/2017 Transaction ID: 2222004885SS636 Amount: 3750

Examination City Opted: DELHI

UNDERTAKING/DECLARATION: I hereby declare that the information furnished by me in the Registration/Application Form is correct and nothing has been
concealed. In case any information furnished by me is found to be false/incorrect/untrue than i shall be liable to civil/criminal prosecution and my claim to
admission/appointment/registration/ service in the Institute may be cancelled/terminated.
Signature of Candidate
Left Thumb of Candidate

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