10/14/22, 1:53 PM https://finalmdmsmch.aiimsexams.ac.in/RegistrationSlip?
id=F/0gUr7pYTsDm57zzp0Z2ih+8hL7zYdqRiDklO8EfI0lEaF2FJGP
All India Institute of Medical Sciences
Ansari Nagar, New Delhi - 110608
Registration Form - Institute of National Importance Combined Entrance Test (INI-CET) for admission to PG courses [MD/MS/M.Ch.(6years)/DM(6years)/MDS]
Jan 2023 Session
Candidate Profile Registration ID: P6181476454 Payment ID: 30022179 Examination Unique Code: 9122262
Candidate Name: SARKAR JAVED AKHTAR Applied Course: MD/MS/MCH(6YRS)/DM(6YRS)
Date of Birth: 18 Nov 1997 Category: OBC (NCL)
Gender: Male Marital Status: Unmarried
Father's Name: MATIFUR RAHAMAN Mother's Name: JAHANARA BEGUM
PWBD Status: No PWBD Category: NA
Nationality: INDIAN Applied Under: Indian National
Identification Mark(1): Black mole over nose Identification Mark(2):
Black mole over right cheek
Are you currently pursuing PG Course in any Subject: NO Do you belong to Karnataka Domicile Category:
NO
Do you belong to North East Domicile Category: NO Do you want to apply for Bhutani National
Candidate : NA
Service in Armed Forces (as per note 3 of Appendix-E)?: NA Service in Central/State Govt. of 3 years or more
(as per note 3 of Appendix-E)? : NA
Applied for PGIMER,Chandigarh under Sponsored Category (Indian National)?: NA Applied for JIPMER,Puducherry under
Sponsored Category (Indian National)? : NA
Applied for AIIMS(Delhi/Rishikesh) and SCTIMST, Trivandrum under Sponsored Do you want to apply for NIMHANS,Bengaluru
Category (Indian National)?: NA under Sponsored Category(Indian National) : NA
Contact Details
Address for Permanent: Correspondence Address:
BIRENDRA SOVA APARTMENT, BIRENDRA DUTTA LANE, UKILPARA, RAIGANJ, Raiganj , North 138 AJC BOSE ROAD,SEALDAH, Intally , Kolkata, WEST
Dinajpur, WEST BENGAL, India, 733134 BENGAL, India, 700014
Mobile No: 1. 7063884333 , 2. Alternate-MobileNo 0 E-Mail ID: [email protected]
Qualification Details
Qualifying Examination Degree From State Name Admission Date Passing Date
MBBS Indian University West Bengal 01/08/2015 04/08/2020
University Name Institute/College Name
WEST BENGAL UNIVERSITY OF HEALTH SCIENCES Nilratan Sircar Medical College, Kolkata
Academic Details
Qualifying Exam Max Marks Marks Obtained Percentage(%)
MBBS 2450.00 1401.00 57.18
Internship Details
Internship Status Internship Start Date Completion/Expected Completion Date No. of Days
Completed 10/08/2020 09/08/2021 365
Medical Registration Details
Registration Type Registration Date Registration Number Registering Authority
Permanent 01/09/2021 88468 State Council -- (West Bengal )
Valid Photo Identity (To be presented in original at the Examination Center along with Admit Card)
ID Proof: Adhar Card ID No: 481935170062 Place of Issue: INDIA Issue Date: NA Valid Till: NA
Do you have experience : No
Payment Details
Mode: Online Date: 14/10/2022 Transaction ID: 14764541017 Amount: 4000
Examination City Opted:
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10/14/22, 1:53 PM https://finalmdmsmch.aiimsexams.ac.in/RegistrationSlip?id=F/0gUr7pYTsDm57zzp0Z2ih+8hL7zYdqRiDklO8EfI0lEaF2FJGP
State: Exam City(Preference 1): State : Exam City(Preference 2): State : Exam City(Preference 3): Exam City(Preference 4):
WEST BENGAL KOLKATA WEST BENGAL SILIGURI WEST BENGAL ASANSOL Any Other City
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
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