VINS

Application Form

VYDEHI INSTITUTE OF NURSING SCIENCES AND RESEARCH CENTRE

NO.82, EPIP area, NALLURHALLI, Whitefield, Bangalore-560066

PB B.Sc. Nursing

STUDENT DETAILS FORM

Sl.No

List

Details

1

Student name

 

2

Date of Birth

 

3

Blood group

 

4

Mother Name

 

5

Mother Mob. No

 

6

Mother E-mail id

 

7

Father Name

 

8

Father Mob. No

 

9

Father E-mail id

 

10

Permanent Address

 

11

Present Address

 

12

Student Mob No:

 

13

Student E-mail id

 

14

Gender

 

15

Religion

 

16

Caste

 

17

Caste Category

 

18

Nationality

 

19

State

 

20

Seat Category (Management/Govt.)

 

21

Qualification Exam

 

ACKNOWLEDGEMENT OF RECEIVING ORIGINAL CERTIFICATE OF

PB.BSc.NURSING 2023-24 BATCH

NAME OF THE STUDENT: _______________________

FATHER’S NAME:_________________________           MOTHER’S NAME: ___________________________

PARENT MOB NO:_______________________              CANDIDATE MOB NO: ________________________

SL

NO

CERTIFICATES

SUBMITTED /

NOT SUBMITTED

1

 

10TH MARKS CARD

 

2

 

12TH / PUC MARKS CARD

 

3

 

GNM MARKS CARD / INTERN COMPLETION / GNM COMPLETION

 

4

 

TRANSFER CERTIFICATE

 

5

 

MIGRATION CERTIFICATE (OTHER THAN PU BOARD)

 

6

 

ELIGIBILITY CERTIFICATE – RGUHS (OTHER THAN PU BOARD)

 

7

STUDY/ CONDUCT CERTIFICATE

 

 

8

PHYSICAL FITNESS CERTIFICATE

 

 

9

ALL CERTIFICATES 2 SETS XEROX COPIES WITH ATTESTATION BY GAZETTED OFFICER

 

10

PASSPORT SIZE PHOTOS 5 NO + 5 NO STAMP SIZE

 

 

11

XEROX COPY OF FEE PAID RECEIPT

 

 

12

XEROX COPY OF PAN CARD AND AADHAR CARD OF PARENTS

 

 

13

XEROX COPY OF AADHAR CARD OF STUDENT

 

 

14

ANTI RAGGING AFFIDAVIT (FORMAT ENCLOSED ,NOTARY HAS TO BE DONE FROM BANGALORE)

 

15

OTHERS

 

 

 

SIGNATURE OF PARENT/GUARDIAN                                                                                                                                                                           SIGNATURE OF CANDIDATE

 

SIGNATURE OF RECIEVER                                                                                                                                                                                                         (PRINCIPAL)