AIIMS Patna | Examination

Student Registration Form

Student Information

Course Name*

Subject*

SESSION*

MARITAL STATUS*

Admission Date*(As per joining report)

Rank*

First Name*

Middle Name

Last Name

Date of Birth*

Blood Group*

Original Category*

Category Selected*

Gender*

Nationality*

Religion*

Email Address*

Identification Mark*

Father Name*

Mother Name*

Parent Email Address

Upload Image*Recent Passport Size Color Photograph in White Background, Maximum Size Allowed 50kb .jpeg file

Upload Signature*Blue/Black Ink on White Background, Maximum Size Allowed 20kb .jpeg file

Contact Details

Correspondence Address

State*

District*

Town/Village*

Police Station*

Pin*

Land Line

Mobile*

Street Address*

Permanent Address

State*

District*

Town/Village*

Police Station*

Pin*

Land Line

Mobile*

Street Address*

Emergency/Local Guardian Contact

Guardian First Name*

Guardian Last Name

Guardian Mobile No*

Guardian Email Address(must be different from student email-id)

Relationship Type

Guardian Address*

Medical/Dental/Nursing Registration Details

Select Name of Coucils or NMC

Permanent Medical Registration No (MBBS)

Name of Medical Council

Permanent Dental Registration No

Name of Dental Council

Permanent Nursing Registration No.

Name of Nursing Council

MD/MS Registration Details

MD/MS Registration Council

Educational Qualification(Under Graduate)

College Name*

State*

City*

University*

Degree Awarded

Passing Year*

% of Marks*

Division*

Educational Qualification (Post Graduate)

College/University Name

State

City

Board/University

Degree Awarded

Passing Year

% of Marks

Division

AIIMS Patna Student Management System

Student Registration Form

Student Information

Contact Details

Medical/Dental/Nursing Registration Details

Educational Qualification(Under Graduate)

Educational Qualification (Post Graduate)