Healthcare - 2019-2020

Registration Form

Name of the Candidate (As per SSC/10th standard) *

Father's Name (As per SSC/10th standard) *

Gender *

Male

Female

Other

Date Of Birth *

SSC/10th standard Hall Ticket Number *

SSC/10th Passed Month and Year of Pass *

Candidate Mobile Number (10 digits) *

Email Id *

Enter Valid Email Id

Fee Amount

Rs. + (Processing charges )

Select the Fee Payment Mode *

BillDesk Payment Gateway

Enter Number displayed above *

Note : Candidate should ensure that the data entered by them including the spellings in the names must be correct and accurate. The responsibility lies solely with the candidate, in case of any mistakes.