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    Nizam'S Institute of Medical Sciences

    Uploaded by

    maaddy001
    This document is an application form for the Post Doctoral Fellowship (PDF) program offered by Nizam's Institute of Medical Sciences for 2022. The 3 page form requests information such as applicant details, contact information, academic qualifications, payment details, and required documents. Applicants must submit the completed form along with documents such as identity proof, address proof, date of birth certificate, qualifying degree certificate, and NOC for in-service candidates by the specified due date.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Nizam'S Institute of Medical Sciences

    Uploaded by

    maaddy001
    49 views3 pages
    This document is an application form for the Post Doctoral Fellowship (PDF) program offered by Nizam's Institute of Medical Sciences for 2022. The 3 page form requests information such as applicant details, contact information, academic qualifications, payment details, and required documents. Applicants must submit the completed form along with documents such as identity proof, address proof, date of birth certificate, qualifying degree certificate, and NOC for in-service candidates by the specified due date.

    Original Title

    PDF_NIMS_Application_Form

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    This document is an application form for the Post Doctoral Fellowship (PDF) program offered by Nizam's Institute of Medical Sciences for 2022. The 3 page form requests information such as applicant details, contact information, academic qualifications, payment details, and required documents. Applicants must submit the completed form along with documents such as identity proof, address proof, date of birth certificate, qualifying degree certificate, and NOC for in-service candidates by the specified due date.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    49 views3 pages

    Nizam'S Institute of Medical Sciences

    Uploaded by

    maaddy001
    This document is an application form for the Post Doctoral Fellowship (PDF) program offered by Nizam's Institute of Medical Sciences for 2022. The 3 page form requests information such as applicant details, contact information, academic qualifications, payment details, and required documents. Applicants must submit the completed form along with documents such as identity proof, address proof, date of birth certificate, qualifying degree certificate, and NOC for in-service candidates by the specified due date.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    NIZAM'S INSTITUTE OF MEDICAL SCIENCES

    (A University Established Under The State Act)


    Punjagutta, Hyderabad-500082,TELANGANA, INDIA

    APPLICATION FORM
    Post Doctoral Fellowship (PDF) - 2022

    For Office Use


    Application No. :
    Affix your Passport Date & Time of Receipt :
    Size Photo here For any Queries Contact:
    Phone: 040-23489905 Email ID: adacnimspdf@gmail.com
    (Send your duly filled Application Form and Copies of Required Documents to
    the above provided Email ID)

    PDF Course Applying Select ....


    For:

    APPLICANTS DETAILS

    Full Name:
    (Name as recorded in qualifying exam certificate. Don’t use Mr./ Miss./ Mrs./ Shri./Dr. etc)

    Date of Birth: Age:

    Gender: Place of Birth:


    Select ....

    In Service Candidate: YES NO

    Aadhar No.

    PARENTS/ SPOUSE DETAILS

    Father’s Name
    (Don’t use Mr../ Shri./Dr. etc)

    Mother’s Name
    (Don’t use Mrs./ Shri./Dr. etc)

    Spouse Name
    (Don’t use Mr./Mrs./ Shri./Dr. etc)

    1
    ADDRESS/ CORRESPONDENCE DETAILS
    Correspondence Address
    Address:

    City: Pin Code:

    State:

    Email ID:

    Mobile No. Phone (with


    STD code):
    Permanent Address Same as Corresponding Address
    Address:

    City: Pin Code:

    State:

    ACADEMIC QUALIFICATIONS
    Note: Please don’t apply, if you don’t requisite qualification as on last date of submission of application form
    EXAMINATION SCHOOL UNIVERSITY/ BOARD/ YEAR OF
    COLLEGE/ UNIVERSITY PASSING
    INSTITUTION
    Intermediate

    MBBS

    Broad Specaility
    Select ....

    Super Speciality
    Select ...

    2
    FOR IN-SERVICE CANDIDATES
    Name of the Organisation :

    Type of the Organisation :

    Current Designation :

    Service Period : From: To:

    No Objection Certificate Obtained from Serving Organisation: YES

    PAYMENT DETAILS
    • All the applicants have to pay an application fee of Rs. 1500/- (Rupees Fifteen Hundred Only)
    • Payment should made by bank transfer to account listed below.
    Name of the Account: DIRECTOR NIMS PANJAGUTTA HYDERABAD
    Account Number: 50100223823186
    Bank: HDFC
    Branch: BANJARA HILLS ROAD NO 7
    IFSC Code: HDFC0004290
    Address: PLOT NO 54, ROAD NO 7, BANAJARA HILLS, HYDERABAD,TELANGANA
    • Please fill in the bank transfer details below:
    Date of Transfer: UTR No:

    Bank Name: Branch:

    Amount Transferred:

    DOCUMENTS TO BE ATTACHED (Please check appropriate box)


    Identity Proof Final qualifying degree certificate
    (PAN Card,Aadhar Card,Passport,Driving License,Voter ID (MD/ MS/ DNB/ DM/ MCh/ DNRB)

    Address Proof
    (Ration Card, Passport, Driving License, Aadhar Card etc.)
    Registration with MCI /State Medical Council

    Certificat showing Date of Birth NOC in case of ‘In-service Candidates'


    (10th Certificate/ Date of Birth Certificate)
    DECLARATION
    I hereby declare that I have read all terms and conditions related to the course. Further, I hereby declare that
    information provided by me in the ‘Application Form’ is true, complete and correct to the best of my knowledge
    and belief. I have not concealed any information. In case any fact mentioned in the Application Form, at any stage
    is found to be wrong/ incorrect my candidature may be cancelled and I may also be prosecuted as per law.

    Signature of the Applicant:

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