11/10/2023, 16:43 AIIMS

All India Institute of Medical Sciences

Ansari Nagar, New Delhi - 110608
Entrance Examination - 2024
Registration Form - Institute of National Importance Super Speciality (INI-SS) for admission to DM, Jan 2024 Session

Candidate Profile Candidate ID: 190003004 Registration No.: 2006509 Registration Date: 04/10/2023

Name: SHAIK SAIFUDDIN Date of Birth: 13/11/1990

Gender: Male Marital Status: Married

Father's Name: SHAIK SALIMUDDIN Category: UR

Mother's Name: SYEDA FARAH ADIBA

Applied Under: General Subject/Specility: Paediatric Gastroenterology

and Hepatology

Nationality: INDIAN

Are you a Ex-serviceman/Commissioned Officer(including ECO,SSCO): NO Designation: NA

Organisation Name: NA PWBD: No

Selected Scribe/Compensatory time option: --

PWBD Category: NA

PWBD Sub Category: NA PWBD %: 0

Contact Details

Address for Correspondence: 19-6-391/1 BAIT UL SHAIKH, SHIVNAGAR NORTH, Permanent Address: 19-6-391/1 BAIT UL SHAIKH, SHIVNAGAR NORTH, , Bidar,
, Bidar, Karnataka, India, 585401 Karnataka, India, 585401
Phone No(s): 1. 9986966601 , 2. 9741802407 E-Mail ID: [email protected]

Qualification Details

S. Level Name of Degree University Name Institution Name Date of Admission Date of Passing
No.
1 Under Graduate MBBS RGUHS BANGALORE JJM Medical College, Davangere 01/08/2008 17/10/2013

2 Qualifying Exam MD RGUHS BANGALORE AL AMEEN INSTITUTE OF MEDICAL SCIENCES 20/04/2016 31/05/2019

Academic Details

Marks Obtained: 2999.00 Maximum Marks: 5050 Percentage: 59.39

Internship Details

Start Date: 25/09/2013 Completion Date: 20/12/2014 No. of Days: 452

Medical Registration Details

Registration Type: Permanent Registering Authority: State Council Reg. Date: 04/07/2019 Reg No.: 108275

Experience/ Employment (Beginning with current)

S. Institute/Hospital Name Experience as Position Held Period Period To Nature of Duties

No. From
1 ST JOHNS MEDICAL COLLEGE SENIOR RESIDENT SENIOR RESIDENT 03/09/2019 02/12/2019 OPD,IPD,CASULATY,NICU,PICU,TEACHING

2 KBN INSTITUTE OF MEDICAL SENIOR RESIDENT SENIOR RESIDENT 02/12/2019 03/05/2021 OPD,IPD,CASULATY,NICU,PICU
SCIENCES
3 KBN INSTITUTE OF MEDICAL ASSISTANT ASSISTANT 04/05/2021 08/10/2021 OPD,IPD,CASULATY,NICU,PICU
SCIENCES PROFESSOR PROFESSOR
4 100BED MCH HOSPITAL SPECIALIST PAEDIATRCIAN 09/10/2021 20/04/2023 OPD,IPD,CASUALTY,NICU,PICU
PAEDIATRICIAN

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

Nature of ID: PAN Card ID No: FYWPS1914Q Place of Issue: BIDAR Issue Date: 19/02/2015 Valid Till:

Payment Details

Mode: ONLINEPAYMENT Date: 11/10/2023 Transaction ID: 30028621204 Amount: 4000.00

Examination Center opted: Hyderabad

Applicant Thumb Applicant Signature

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.

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