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All India Institute of Medical Sciences: Registration Form - AIIMS-PG MDS, January 2018

This document is a registration form for Pooja Shetye to take the AIIMS entrance exam for postgraduate medical studies. It provides her personal details like name, date of birth, address, education qualifications including a BDS degree from Mahatma Gandhi Missions Dental College. It also includes details of her internship, medical registration, valid photo ID, and payment for the exam registration. Pooja declares that the information provided is correct.

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97 views1 page

All India Institute of Medical Sciences: Registration Form - AIIMS-PG MDS, January 2018

This document is a registration form for Pooja Shetye to take the AIIMS entrance exam for postgraduate medical studies. It provides her personal details like name, date of birth, address, education qualifications including a BDS degree from Mahatma Gandhi Missions Dental College. It also includes details of her internship, medical registration, valid photo ID, and payment for the exam registration. Pooja declares that the information provided is correct.

Uploaded by

pooja
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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9/21/2017 AIIMS

All India Institute of Medical Sciences


Ansari Nagar, New Delhi - 110608
Entrance Examination - 2018
Registration Form - AIIMS-PG MDS, January 2018

Candidate Profile Candidate ID: 717177218 Registration No.: 337190 Registration Date: 20/09/2017

Name: SHETYE POOJA PRAMOD Date of Birth: 15/11/1990

Gender: Female Marital Status: UNMARRIED

Father's Name: PRAMOD ANANT SHETYE Category: UR

Mother's Name: PRANITA PRAMOD SHETYE Disability Status: No

Nationality: INDIAN Disability Option: --

Identification Mark(1): MOLE ON RIGHT SIDE OF NECK Identification Mark(2): BURN MARK ON RIGHT
HAND
Applied Under/Department: General/--

Contact Details

Address for Correspondence: B/ 404 MULUND SIDDHIVINAYAK SOCIETY TATA Permanent Address: B/ 404 MULUND SIDDHIVINAYAK SOCIETY TATA COLONY
COLONY NAVGHAR ROAD MULUND EAST MUMBAI 400081, Mumbai City, NAVGHAR ROAD MULUND EAST MUMBAI 400081, Mumbai City, Maharashtra,
Maharashtra, India, 400081 India, 400081
Mobile No(s): 1. 9820621407 , 2. 9664170689 E-Mail ID: [email protected]

Qualification Details

S. Qualifying Exam Name of Institution University Date of


No. Degree Passing
1 Undergraduate BDS Mahatma Gandhi Missions Dental College & Hospital, MAHARASHTRA UNIVERSITY OF HEALTH 28/02/2014
Navi Mumbai SCIENCE NASHIK

Academic Details

Marks Obtained: 2013 Maximum Marks: 3600 Percentage: 55.92

Internship Details

Internship Status: Completed Internship Start Date: 10/03/2014 Completion Date: 10/06/2015 No. of Days: 458

Medical Registration Details

Registration Type: Permanent Registering Authority: State Council Reg. Date: 05/11/2015 Reg No.: A-31087

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

Nature of ID: Adhar Card ID No: 413864841767 Place of Issue: MUMBAI Issue Date: 06/11/2011 Valid Till:

Payment Details

Mode: ONLINEPAYMENT Date: 21/09/2017 Transaction ID: 100015638891 Amount: 1000.00

Examination Center opted: Mumbai

DECLARATION: I hereby declare that the information furnished by me in the Registration 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.

Candidate Signature Candidate Thumb

http://mdmsmch.aiimsexams.org/Applicant/AIIMSApplicantPrintForm.aspx 1/1

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