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Aiims Registration Form

This document is a registration form for Maria Seemi to take the INI-CET exam for admission to postgraduate medical programs at AIIMS. It provides her personal details such as date of birth, gender, identification marks, contact information, and voter ID as proof of identity. By signing the form, Maria declares that the information provided is correct and understands she could face prosecution if any information is found to be false.

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Saalis Umer
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147 views1 page

Aiims Registration Form

This document is a registration form for Maria Seemi to take the INI-CET exam for admission to postgraduate medical programs at AIIMS. It provides her personal details such as date of birth, gender, identification marks, contact information, and voter ID as proof of identity. By signing the form, Maria declares that the information provided is correct and understands she could face prosecution if any information is found to be false.

Uploaded by

Saalis Umer
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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All India Institute of Medical Sciences

Ansari Nagar, New Delhi - 110608

Registration and Basic Candidate Information Form - Institute of National Importance Combined Entrance Test (INI-CET) for admission to PG courses [MD/MS/M.Ch.
(6years)/DM(6years)/MDS]

Candidate Profile Registration ID: P6131226109 Registration Date: 10/02/2019

Candidate Name: MARIA SEEMI

Date of Birth: 09 Feb 1990 Category: General

Gender: Female Marital Status: Married

Father's Name: SHAKEEL PARWAIZ Mother's Name: SITWAT BANO

PWBD Status: No PWBD Category: NA

Nationality: INDIAN

Identification Mark(1): A MOLE ON THE RIGHT SIDE FOREHEAD Identification Mark(2):


LIGHT COLORED MOLE ON LEFT PALM

Contact Details

Address for Permanent: Correspondence Address:


C/O MARIA COSMETICS, OPP URDU GIRLS HIGH SCHOOL, A21 POCKET 9A JASOLA VIHAR, New Friends Colony , South
CHANDWARA, Pakki Sarai , Muzaffarpur, BIHAR, India, 842001 Delhi, DELHI, India, 110025

Mobile No: 1. 9911847759 , 2. Alternate-MobileNo 0 E-Mail ID: [email protected]

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

ID Proof: Voter ID/EPIC Card ID No: NWD4588975 Place of Issue: DELHI Issue Date: NA Valid Till: NA

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
Thumb of Candidate

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