All India Institute of Medical Sciences
Ansari Nagar, New Delhi - 110029
AIIMS Undergraduate Basic Registration Form
Candidate Profile Registration ID: U5342807614 Basic Registration Date: 21/04/2025
Candidate Name: PRIYA Date of Birth: 28 Sep 2007
Gender: Female Category: EWS
Father's Name: SURENDER Mother's Name: NEELAM
PWBD Status: No PWBD Category: NA
Nationality: INDIAN State of Domicile: HARYANA
Contact Details
Address for Permanent: Correspondence Address:
VPO HASSANPUR, TEHSIL JHAJJAR, JHAJJAR, Jhajjar , Jhajjar, VPO HASSANPUR, TEHSIL JHAJJAR, JHAJJAR, Jhajjar , Jhajjar, HARYANA,
HARYANA, India, 124103 India, 124103
Mobile No: 1. 8814953509 , 2. Alternate-MobileNo E-Mail ID: [email protected]
8814953509
Valid Photo Identity (To be presented in original at the Examination Center along with Admit Card)
ID Proof: Aadhar Card ID No: 252789117718 Place of Issue: India 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
