Rajasthan Nursing Council,

Jaipur

Passport size
Photo of the
applicant.

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

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.