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Application Form For Migration
Candidate have to verify their Original Documents.All documents must be attested by principal of the Institute
केवल वही छात्र भरे जो दूसरे स्टेट से मध्यप्रदेष मे आना चाहते हो। ऑन लाईन फार्म के साथ अपने समस्त दस्तावेजो की दो प्रति संलग्न करे।
नोटः- ए.एन.एम से जी.एन.एम एवं जी.एन.एम से पोस्ट बेसिक वाले छात्र यह फार्म न भरे।
Field's marked with * are mandatory
Registration Details
Migration Required*
Personal Details
Applicant's  Name
(Don't use Mr./Mrs./Ku.) *
Father's / Husband Name* Mother's Name
DOB(DD/MM/YYYY)* Age(Till Current Date)
Marital Status * Religion *
Caste Nationality *
Gender * Category *
M.P. Domicile*
Other State*
Mobile Number *
Email* Institution Recognized by INC*
Training Details
Name of Examination University/Council from which Qualified*
Training Center Name
Training Period From Date(DD/MM/YYYY)* Training Period To Date(DD/MM/YYYY)*
Are you Completed Your 6 Moths InternShip(G.N.M.)
Training Center Address *
Candidate Address
Current Address *
Pin Code * Permanent Address(Same as Current Address)
Permanent Address *
Pin Code *
Educational Qualification Details
Sn.ExamNameBoard NameSubjectPass YearPercentageRollNumber
1 High School(10th)*
2 Higher Secondary(12th)*
3 ANM/GNM/B.Sc Nursing (Enter Highest Qualification)*
4 Other1
Annexure, Testimonials & Particulars Registration MP Nurses Council or Other Council
1. Annexure*

2. Copies of Testimonials* (Name, Address & Designation of testifying Persons and date of issue of testimonial)
Testimonials Person 1 Testimonials Person 2
3. Particular Regarding Registration with the Madhya Pradesh Nurses Registration Council Bhopal or with any other Council.
Sno.Nursing Council where
Previously Registered
Reg.No.Reg.Date(DD/MM/YYYY)Category in Which Registered Such AsOther




Work Experience
Work Exp.(From Date)(DD/MM/YYYY)* Work Exp.(To Date)(DD/MM/YYYY)*
Name of Work Place* Address of Work Place*
Have you ever been penalized by any Court Law ?*

Upload your photo*
(Min 15 kb -Max. 50 kb)(Only .Jpg Format is Allowed)
* I enclose original copies of certificates of qualification as detailed below, which may please be returned to me. I also enclose Two recent testimonials by respectable and well known citizens of my town/village including one by a Medical Officer not below the rank of Assistant Surgeon or a private Medical Practitioner holding registrable medical qualifications. I hereby undertake that if I am admitted to register, I will , in the practice of my profession as a observe and be bound by the provision of the Act and the rules and byelaws made or order and instructions, issued there under so far as they affect me and if the Council shall at any time after due enquiry order my name to be removed from the register. I will return to Registrar the certificate and badge (If any) issued to me by the council.
Note:- 1.Candidate have to verify their Original Documents . All documents must be attested by principal of the Institute