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WithIn State Nurse Additional Qualification Application
Note: Fill all the Details carefully. Once you have submitted the application, you will not be able to edit any information.
Nurse Application Details
Institute Name :
*
Examination Passed :
*
Application Date :
*
Unique No :
*
Seat No :
*
GNC Registration No :
*
Application No :
Name :
*
Speciality :
*
Sub Speciality :
*
Passing Board / University :
*
Exam Month :
*
Exam Year :
*
Degree Certificate No :
*
Degree Certificate Date :
*
Final Year Total Mark :
*
Obtained Marks :
*
0%
House / Block No. Scociety :
*
Landmark Address :
*
State :
*
District :
*
Taluka :
*
City :
*
Pincode :
*
Postal Address :
*
House / Block No. Scociety :
*
Same As Above
Landmark Address :
*
State :
*
District :
*
Taluka :
*
City :
*
Pincode :
*
Date of Birth :
*
Birth Place :
*
Email :
Mobile No :
*
Gender :
Adhaar No :
*
Marital Status :
*
Nationality :
*
Training Period
1) :
*
To
I here by declare that all the documents & information submitted in this application form are true to the best of my knowledge. I understand that if any of the information is found wrong, my application will stand cancelled. I shall abide by the rules & regulation in force in Gujarat Nursing Council and as amended from time to time.
Applicant Photo
*
(Maximum Photo Size Limit 500 KB)
Document to Upload
*
(Maximum File Size Limit 500 KB)
GNC Registration Certificate
1
gnc
Diploma Certificate
1
diploma
Registration Renewal Slip (if Applicable)
1
test
PBBsc Degree Certificate
1
degree
PBBsc Nursing Marksheet(All Marksheets in one PDF Only)
1
pbbsc
PBBsc Nursing Course Completion Certificate
1
pbbsc
Adhar Card
1
adhar
Online Payment Receipt of University (If Applicable)
1
test
Online Payment Receipt of University/Diploma Board
Course Completion Certificate
Additional Education Qualification Certificate
Final Examination Marksheet (NPME)
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