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B.Sc Nursing Application Form for the Academic Year 2022

    Name of the Student
    (in Block Letters)
    Postal Address with Pincode
    State / Nativity
    Upload Your Photo (Photo size should be below 500kb)
    Country / Nationality
    Mobile No/Land Phone No
    Email Address
    Gender
    Date of Birth & Age
    Blood Group
    Religion & Caste
    Category (Tick Your category)
    Marital Status
    Adhaar Number
    Name, Occupation &
    Mobile No of Father
    Name, Occupation &
    Mobile No of Mother
    Income (Rs.)

    Academic Qualification

    1. SSLC
    2. HSE/CBSE/ICSE/VHSE
    Subjects in HSE/ CBSE/ICSE/VHSE
    Physics
    Chemistry
    Biology
    English
    Co – Curricular Activities
    Year of Passing with Month
    Migration Certificate No
    Admission Quota
    Place of Stay
    If Day scholar, distance from
    Home town to College
    Payment A/C Information

    Name : Palakkad Institute of Medical Sciences
    Bank : AXIS Bank
    Account No : 920010066736358
    Branch : Chandranagar
    IFCE Code : UTIB0003000

    Upload Your Payment receipt
    Upload Your Signature