All India Institute of Medical Sciences

Ansari Nagar, New Delhi - 110608

Entrance Examination - 2017
Application Form - AIIMS MBBS 2017

Candidate Prole Candidate ID: 5171422686 Registration No: 2369038 Registration Date: 22/02/2017

Candidate Name: R SHALINI Date of Birth: 05 Mar 1999

Gender: Female Category: OBC (NCL)

Father's Name: R RAJA CHANDRA SEKAR Mother's Name: R MANJUKUMARI

OPH Status: No OPH %: NA

Nationality: INDIAN State of Domicile: Tamil Nadu

Have you appeared at AIIMS MBBS Entrance Exam earlier: No Year of appearance: NA

Language in which Question paper is desired: English

AIIMS Preference

Preference 1 : AIIMS-Delhi Preference 2 : AIIMS-Bhubaneswar Preference 3 : AIIMS-Bhopal

Preference 4 : AIIMS-Jodhpur Preference 5 : AIIMS-Patna Preference 6 : AIIMS-Raipur

Preference 7 : AIIMS-Rishikesh

Contact Details

Address for Permanent: Correspondence Address:

46 D/A NEW NO.9, NEW STREET, KAJA PETTAI (NEAR SABARI HOSPITAL), H-105, PHASE-1, ANNA NAGAR (NEAR RAMANATHAN RICE SHOP),
Tiruchirappalli, Tamil Nadu, India, 620001 Tiruchirappalli, Tamil Nadu, India, 620026

Mobile No: 1. 9489036375 , 2. Alternate-MobileNo 7598456949 E-Mail ID: rchandrasekar1970@gmail.com

Qualication Details

Qualifying Exam Qualifying Exam Status Class 10th Roll no. Exam Board Name State Name

SSC Exam(10+2) Appearing 4125792 CBSE Tamil Nadu

Academic Details

Qualifying Exam Status Scoring Scheme Max Marks Marks Obtained Percentage(%)

Appearing NA 0.00 NA NA

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

ID Proof: School Identity Card ID No: 2016 2017 Place of Issue: TIRUCHIRAPPALLI Issue Date: NA Valid Till: NA

Payment Details

Mode: Online Date: 22/02/2017 Transaction ID: 142268699 Amount: 1000

Examination City Opted: Other

UNDERTAKING/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.

Signature of Candidate
Thumb of Candidate