ASSAM
 
APPLICATION FOR REGISTRATION UNDER ASSAM NURSES AND MIDWIVES REGISTRATION COUNCIL , ASSAM, ASSAM (FOR ANM / GNM / B.Sc (N) / P.B.Sc (N)/ M.Sc (N) COURSES)
 
First keep ready the Scan copy of Documents mentioned against (a) (b) (c) (d) in .jpg / .jpeg Formats and then fill up the details information as mentioned below
* Minimum Requirements
(a) Require amount of Challan paid through SBI e-Pay / SBI Collect through Online Mode Only (No Bank Draft will be accepted) *
(b) Scan copy of passport size photograph (colour) and Signature *
(c) Scan copy of Existing Registration Certificate Both Front and Back side (Applicable for Renewal and Reciprocal Registration only) *
(d) Scan Copy of College Leaving / Trg. School Leaving Certi. from Institute Last attended and Pass Board Certificate (For Fresh Registration Only) *
 
Please Fill up the Following Information to apply for Fresh Registration / Renewal of Registration/ Duplicate Registration / Reciprocal Registration / Additional Registration in , ASSAM
 
Please select the type of Registration *(Fresh/Renewal/Reciprocal/Duplicate etc)
  
Please select the Course you have passed out *
Please enter the Name of Speciality (For MSc only)
 
Please select the Year of passing of the Course *
  
Please select the Name of the Institution from which you have passed out *
  
If select others ,please enter the Institute name  
Enter SBI e-Pay / SBI Collect Reference No (DUXX)*
 
Enter SB Colect Reference No if any(IGXX or DUXX)*
  
Please enter the Amount Paid (INR) *
  
Please enter the Date of Payment *
  

Enter your Full Name (As per 10th certificate) *

  
Enter your Father Name (As per 10th certificate)*
 
Enter your Mother's Name
 
Date of Birth (As per 10th certificate) *
    
Gender / Sex *
  
Please enter your Address Details *
(At-Po-PS-Via-Dt-Pin)
 
Please enter your Contact Valid Mobile No *
  
Please enter your valid e-mail ID *
  
Please enter your 12 Digit Adhar Number *
  
Examination held in the Month, Year *
(like June 2018)
(As mentioned in Pass Certificate or Regd. Cert)
 
Duration of the Course (From)/ Date of admision / Joining in the Training *
  
Duration of the Course (To)/ Date of Completion / relieving from the Training *
  
Roll no issued by Nursing Board / University
(Applicable For New / Fresh Registration)
 
Existing Registration Number given by
(For Renewal / Duplicate / Reciprocal Regd. only )
 
Existing Registration Date
(For Renewal / Duplicate / Reciprocal Regd. only )
    
Existing Registration Validity Till
(For Renewal / Duplicate / Reciprocal Regd. only )
   
Name of the Examining Body / Board / University *
  
Date of declaration of the Result (As per certificate)
 
Upload your Signature *
(Scan Copy of Full SIgnature)
 
Upload your photo *
(Passport size colour photo in Professional Attire)
 
Upload Scan Copy of  School Leaving (For Fresh/ New Registration) or Scan copy of Front Page of Existing Registration (For Renewal/Reciprocal Registration)
  
Upload Back Side of  your Existing Registratioon Certificate (For Renewal Registration) or Scan copy of Nursing Passout Board certificate (For Fresh/ New Registartion)