Application Form.pdfnish

4/25/2014 Application Form

http://www.formzero.in/index.php?module=institute&section=courseapplication&event=view&method=view&stageid=330&id=B-Sc-Nursing 1/3

Institute Of Medical Sciences

Banaras Hindu University

APPLICATION FORM FOR B.Sc Nursing 2014

Last date of receipt of duly filled online application: 04.05.2014, till 11:59PM

Candidates are adviced to read the instructions in this link carefully before filling up the registration form

Note : Fields marked with a red asterisk are mandatory for submission of the form. Please keep on clicking the save

button on the top right corner while filling the form to make sure you do not lose any data due to network connectivity

issues. Click on the submit button for finally submitting your data.

First Name

Date of Birth

Category

Application Fee

NEHA

21-11-1995

OBC(non-creamy layer)

1000

Middle Name

Sex

Female

Last Name

Nationality

Only Indian Nationals are allowed

SINGH

India

Person with disability ?

Physically challenged (PC) candidates are not eligib le for B.Sc. nursing course

No

Father's Name

RAKESH KUMAR SINGH

Mother's Name

SHARMILA DEVI

Contact information for Correspondence

http://www.formzero.in/media/instituteImages/11663/files/Information_Brochure_B__Sc_Nursing_2014.pdf



House No.

District

Telephone No. with STD/ Mobile

SHIVAPAR(TP NAGAR) NEAR TIWARI

HOTEL

SONEBHADRA

8858242890

Street / Post & Thana

State

Email

POST-PIPARI

UTTAR PRADESH

[email protected]

City

Pin

Mobile Number

RENUKOOT

231217

8858242890

Permanent contact information same as Correspondence ?

I.Sc / 10+2 or equivalent ?

Yes

Appearing

Marks in Intermediate or equivalent examination

Marks obtained in English

Write "NA" if not applicable

Maximum Marks in English


Marks obtained in Biology


Maximum Marks in Biology


Total marks obtained (4 subjects)


NA

NA

NA

NA

NA

Marks obtained in Physics


Maximum Marks in Physics


Marks obtained in Zoology


Maximum Marks in Zoology


Total Maximum marks (4

subjects)


NA

NA

NA

NA

NA

Marks obtained in Chemistry


Maximum Marks in Chemistry


Marks obtained in Botany


Maximum Marks in Botany


NA

NA

NA

NA

DISCLAIMER : Submission of this form alone does not mean that you have successfully applied to the above-

mentioned course. You MUST complete all the stages of the application process (including payment, successful

document upload, etc) to be eligible for selection.

DECLARATION BY THE CANDIDATE

1. I have read the information and instruction booklet carefully.

2. I am an Indian Citizen and have not taken part in any activity subversive to law.

3. The Application Form has been dully filled and signed by me. All the information furnished herein is true and

complete and nothing has been concealed or distorted. If any time it is found that the entries made in my Application

Form are incorrect or any of the information has been concealed or distorted, my admission to B.Sc Nursing course at

the IMS, Banaras Hindu University, shall be liable to be summarily cancelled without any notice whatsoever by the Head

of the Institution.

4. I shall abide by the decision of the Head of the Institution in all matters of admission, discipline, examination,

residence, attendance in the classes and shall abide by the Rules & Regulations of the Banaras Hindu University.



5. I promise to submit/show original copies of all my Educational Qualification Certificates, Mark Sheets as well as other

relevant Certificates at the time of my admission to the Admission Committee. In the event of failure to do so, my

admission to IMS, BHU shall stand cancelled.

6. I understand that if I fail to submit relevant documents / fulfill the essential criteria for admission, my candidature shall

stand cancelled forthwith even if I have secured success in the merit list of entrance test results.

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Application Form.pdfnish