Rajasthan Nursing Council, Jaipur

B-39, Sardar Patel Marg, C- Scheme, Jaipur, Ph- 2222923

Application to the Registrar for Registration of Additional Nursing Qualification

Applicants Details Candidate Name

Fathers Name Date of Birth

Sex

Nationality

Permanent Postal Address

Additional Nursing Qualification Details

Name of Additional Nursing Qualification

Name of the Nursing School/College

Period of training

Name of Examination Body

Details of Nursing Course Passed

Name of the Course

Name of the School/College

Period of Training

Name of Examination Body

Nurse Registration Details

Name of the Nursing Council

Registration No.

Registration Date

I ..hereby declare that the above details given are true to the best of my knowledge and belief. I pay herewith prescribed fee of Rs. for registration of additional nursing qualification at Rajasthan Nursing Council, Jaipur.

Jaipur

Dated . Signature of the Candidate Instructions overleaf

Passport size Photo of the

applicant.

Instructions

1. The applicant must be registered with Rajasthan Nursing Council, Jaipur and have

his/her active registration no as RN/RM.

2. Registration fee of Rs.1000/- per additional nursing qualification is to be remitted in the

form of Demand Draft drawn in the favour of Registrar, Rajasthan Nursing Council,

Jaipur. Fee once deposited will not be refunded in any condition.

3. In case of Registration of more then one additional Nursing Qualification different

applications are required to be submitted.

4. The additional nursing Qualification will be registered from basic to higher qualification

in Systematic manner.

5. The application must accompany the following certificates:

a. Original Diploma/Degree certificate of additional nursing qualification with

attested photocopy.

b. Original Registration Certificate of Nursing Council with attested photocopy.

c. Original marksheets of additional nursing qualification attested photocopy.

d. Original of Diploma/Degree attested photocopy.

e. Original secondary certificate (proof for Date of Birth) attested photocopy.