MAHAKOSHAL NURSES REGISTRATION COUNCIL APPLICATION FORM FOR RECORDING ADDITIONAL Prepaid QUALIFICATION IN THE REGISTER Rs. 25/- Vide PASPORT R. No. ....... Dated ....... SIZE PHOTO I, -------------------------------------------------------------------------------- (Name in full and Block Letters) of (Permanent address in Full)---------------------------------------------------------------------------- hereby apply to* record my following qualifications (original and copy of which is enclosed) in Register:- I was trained at----------------------------------------------------------------------------------------------- Passed the----------------------------------------------------------------------------------------------------- Examination held by -------------------------------------------------------------------------------------in the year-----------------------------. I am registered in Mahakoshal Nurses Registration Council(If from other council, name of the council) --------------------------------------------------------------------------------------------------as a Nurse/ Midwife/G.N.M.(New course) under No.------------------------------------------------------. Present address:--------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------. Requirements: 1. Fees :- Rs. 100/- by Bank Demand Draft in favour of Registrar Mahakoshal Nurses Registration Council. 2. Original Certificate, Latest Photograph- 2 Passport Size. 3. Attested 2 Photocopies of all original certificates. Date:- ------------------------------------------------- (Signature of the applicant) Signature & Seal of Head of Training Centre. To, The Registrar, Mahakoshal Nurses Registration Council M-78, Block No. 9 Harshwardhan Nagar Bhopal,(M.P.)
