web copy certificate
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U.P. NURSES & MIDWIFES COUNCIL

5, Sarvapalli, Mall Avenue Road, Lucknow - 226001

Phone: 0522-2238846, Fax: 0522-2236600

Website: www.upnursescouncil.org

APPLICATION FORM FOR GOOD STANDING

(Fill the form in capital letters)

1.

Name of the Candidate in full & address (as given on the Registration Certificate)

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2.

Father's Name

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3.

Present Address

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4.

Mobile Number

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5.

E-mail id

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6.

Professional Qualification

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7.

Name of the Training Center (Where training has been received)

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8.

Registration Number

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9.

Place where you worked with full details (Enclose certificate in support)

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(Signature of the candidate)

Note:Please fill the information as per your Registration Certificate,