Bishop Benziger College of Nursing
Kollam, Kerala – 691001
Application for Admission under NRI Quota
B.Sc. Nursing
Application Number
New Application
Name
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Gender
DOB
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Religion & Caste
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Nationality
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Native Place
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Parent or Guardian Details
Name
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Address
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Telephone Number
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Mobile Number
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Email ID
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Educational Qualification
Qualification
Board of Examination
Name of the Institution
Month & Year of Passing
Reg No
Marks Secured
Grand Total
Percentage %
A
S.S.L.C
S.S.L.C
Board of Examination
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Name of the institution
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Month & Year of Passing
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Register No
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Mark Secured
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Grand Total
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Mark %
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B
Plus Two
Plus Two
Board of Examination
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Name of the institution
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Month & Year of Passing
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Register No
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Mark Secured
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Grand Total
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Mark %
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HSE Subject Marks
English (2nd Year)
Mark Secured
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Max Mark
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Mark %
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Physics (2nd Year)
Mark Secured
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Max Mark
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Mark %
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Chemistry (2nd Year)
Mark Secured
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Max Mark
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Mark %
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Biology (2nd Year)
Mark Secured
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Max Mark
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Mark %
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Total (PCB)(2nd Year)
Mark Secured
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Max Mark
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Mark %
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Total (PCBE)(2nd Year)
Mark Secured
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Max Mark
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Mark %
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Sponsor Details
Name of Sponsor
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Relationship
Passport No. & Expiry Date
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Visa No. & Expiry Date
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Address(Indian)
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Address (Abroad)
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Phone Number
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Email ID
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Declaration
We, ___________________________ (Applicant)& ___________________________ (Parent/Guardian) do hereby solemnly declare that the statements made herein above are true to the best of my knowledge and belief. Should the said information prove to be incorrect at any stage, my candidature/admission to the B. Sc. Nursing course shall stand cancelled. We promise to submit all certificates and documents in original at the time of admission failing which the admission will be liable for cancellation. We agree to pay an additional fee of Rs. 31500/- every year as per Government Order. If student discontinues the course after the closure of admissions I will pay the liquidated damages equal to 4 times the Annual Tuition Fee paid by her for the first year irrespective of Annual Family Income/Nativity/Reservation status (Order No. G.O. (MS) No. 172/2013/H&FWD, TVM, dated 16/05/2013).
Name of Applicant
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Applicant Signature
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Name of Parent/Guardian
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Parent/Guardian Signature
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Date
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Place
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Documents attached
Copies of the documents are to be attached. Original documents and certificates are to be handed over to the college at the time of admission.
1. X Certificate in proof of Date of Birth
2. Copy of the qualifying examination certificate ( 10+2)
3. Character/Conduct certificate from the institution last attended within six months.
4. Transfer Certificate
5. Migration Certificate
6. The candidate is required to submit NRI Documents of parent or sponsor.
7. Eligibility Certificate indicating equivalence of 10+2 from Kerala University of Health Sciences (if applicable)
8. Equivalence Certificate from Association of Indian Universities (if applicable)
Student's Photo
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X th Certificate in proof of Date of Birth
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Copy of the marks sheet of qualifying examination certificate ( plus 2)
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Character/Conduct certificate from the institution last attended within six months
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Transfer Certificate
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Migration Certificate
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Sponsor’s attested copy of passport
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Sponsor’s attested copy of green card/ employment certificate/ Visa (Overseas employment certificate)
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Relation certificate of student with sponsor from revenue authority
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Completed copy of Annexure 1 of Prospectus
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Eligibility Certificate from Kerala University of Health Sciences Trissur, if candidate completed her plus two in foreign country (If applicable)
Please Upload Eligibility Certificate from Kerala University of Health Sciences Trissur, if candidate completed her plus two in foreign country (If applicable).!
Equivalence Certificate from Association of Indian Universities (if applicable)
Please Upload Equivalence Certificate from Association of Indian Universities (if applicable).!