dkf.org

Application Form

APPLICATION FORM FOR
Fellowship in Nursing Laws and Ethics (FNLE)
SESSION 2018 - 2019

Name:

Image:

Date of Birth:

Age:

Sex:

Category:

Nationality:

Region:

Examination	Passed/Appeared(Year)	Board/University/Authority Place and Country	Marks
Examination	Passed/Appeared(Year)	Board/University/Authority Place and Country	Max Marks	Percentage Obtained

Address for Correspondence (Please include State, Telephone, Fax, e-mail, other details (if any) (Any change in the address may please be intimated immediately):

Pin Code:

Phone with STD:

Mobile No:

Fax:

E-mail:

Only for Foreign Nationals or NRIs

Nationality (enclose proof):

Passport Number:

Passport issuing Country:

Date of Issue:

Date of Expiry:

LIST OF ENCLOSURES:

Decription	Upload	Status
Copy of the Passport (Essential for Foreign Nationals)
Copy of the statement of marks of the Qualifying Examination /conversion in the case of Grades / Graduation Certificate
Copy of the Birth Certificate or any other equivalent document for D.O.B.
One Passport size photograph
Signature scan copy

N.B. : If you do not have a passport, please enclose copy of Aadhar card or Voter ID card as proof of identity. If you have appeared for graduation, please enclose copy of your
admit card or equivalent document. All documents must be self attested.

DECLARATION:

I hereby affirm that the information furnished in the Application Form is true and no material information has been concealed. If any information is found to be false, incorrect or misleading, the University shall have the authority to cancel my candidature / admission without any further enquiry or notice. 1 undertake to abide by the Regulations and disciplinary rules already in force and such other rules that may be made by the Authority from time to time, if admitted.

Application Form

Only for Foreign Nationals or NRIs

LIST OF ENCLOSURES:

DECLARATION:

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