Online Application Form for GNM 2021-2022 To, The Principal, KLES Institute of Nursing Sciences, Main Road, KLES M M School Campus Gokak-591307 Sir/Madam, I the undersigned wish to seek admission to the 1st Year General Nursing and Midwifery Course in your institution. I am giving below the following particulars and undertake that if admitted I agree to be bound by the rules & regulations in force as well as those that may be framed in the future by the institution. I have attached all the original documents and attested copies of all necessary documents with this admission form. Year of Admission Name of the State Full Name of the Candidate (As per 10th Certificate ) Gender —Please choose an option—MaleFemale Age Date of Birth Aadhar Card No. Contact No. E-mail Address Name of the Father Occupation Annual Income Contact No. E-mail Address Language Known Nationality Religion Caste Permanent Address Local Address 2nd PUC or 12th Standard Main Stream —Please choose an option—ScienceCommerceArts Name of the School or College with Address Name of the 12th Board Month & Year of Passing Marks & Percentage of 12th Standard Total Marks Obtained Marks Percentage Subject studies at 12th standard Upload Certificates (Upload files in .jpg or .pdf format, maximum size 100 KB Upload Recent Passport Size Photo Upload 12th Certificate Upload 10th Certificate Upload 12th Leaving Certificate Upload Medical Certificate Upload Migration Certificate (Non Karnataka Students Only) Demand Draft Information D.D. the favor of PRESIDENT KLE SOC BELAGAVI FOR KLES NURS. For online payment bank details: Name of the account: PRESIDENT KLE SOC BELAGAVI FOR KLES NURS. Name of the Bank: Canara Bank Branch: Gokak Ac. No.: 2763101013441 IFSC CODE: CNRB0002763 MICR CODE: 591015502 Name of the Bank: DD No. / Transaction No. / NEFT Ref. No. Transaction Date Amount Declaration 1. I hereby declare that the above information is true and complete to the best of my knowledge. I am aware that if any information herein is found to be incorrect or incomplete, my application form will be rejected / admission will be cancelled. 2. If admitted to KLES Institute of Nursing Sciences - Gokak. I shall abide by its Rules and Regulations. 3. I have read and understood all the provisions contained in the brochure and hereby agree to abide by these provisions. 4. The candidate should cross-check all the details filled in the on-line application, before finally submitting the same, as no correction / no refund of fees after submitting the form Aggred with terms & declaration Δ
