Uploaded by Arina Chandrababu

Al-Hind Registration Form

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J)fp AL-HIND FOREIGN SERVICE AGENCY
No.73, Main Road, Near State Bank, Zakir Nagar, New Delhi-110 025 (India)
Ph:0091-11-26983980, 26983981,26988375 I 76, Fax:0091-11-26983982
E-mail: _info@al-hind.com, Web: www.al-hind.com
FOR OFFICIAL USE ONLY
I
Registration Date:
I
Registration No:
(Paste recent
Photo graph with
white background)
OBGYN
POSITION APPLIED FOR:
I
Arina Vishnuvarthan
Full Name
Fathers Name
I
--
Chandrababu Surendran
Marital Status
Married
Spouse Name
Place of Birth
Kerala
Date of Birth
Sreekala Chandrababu
Mothers Name
Vishnu Varthan Perumal
Female
Sex
31
Age __ _ _ yrs
12.03.1992
Hindu
Religion
Indian
Nationality
A 1801, Concept Unnathi, Plot no 69 A,B,E,F, Sector 21, Kharghar, Navi Mumbai 410210
Address:
City:
Mobile No:
Phone No:
Y ECNR
D
PASSPORT TYPE
Z6759368
Passport No:
+919820033230
Navi Mumbai
Email:
Pin:
410210
arina_cb@yahoo.co.in
DeeR
Place of Issue:
Mumbai
Date of Issue:
09.05.2022
08.05.2032
Date of Expiry:
EDUCATIONAL QUALIFICATION
S#
1
Course Name
Specialisation I Subject
MBBS
Month & Year Passing
Institute Name & Location
(Month /Year)
Dr D Y Patil School of Medicine
03.2015
2
MS OBGYN
OBGYN
MGMIHS, Navi Mumbai
07.2018
3
MRCOG
OBGYN
RCOG, London
06.2023
4
EXPERIENCE DETAIL
Total Years of Experience
S#
Employer's Detail
Department
3
From
(Date/Month/Year)
To
(Date/Month/Year)
1
Sathya Sai General Hospital
Obgyn
01.10.2018
24.10.2019
2
Pulkit Memorial Hospital
Obgyn
13.02.2020
05.09.2021
3
Karjat Medical College
Obgyn
01.02.2022
31.07.2022
4
Samarpan Hospital
Obgyn
15.07.2023
DECELERATION
A.
I hereby declare, that all the information given above is true and genuine .
I authorize, M/s AL-HIND FOREIGN SERVICE AGENCY to submit my original certificates (Educational Certificate & Work Experience) for
verification from the issuing university and Attestation from the Ministry of External Affairs, Cultural Attache Office and Royal Embassy of Saudi
Arabia, for the purpose of visa endorsement.
c. I hereby declare, that after selection/issue of my visa/visa endorsement in my passport, if for any reason I cannot travel to country of my
employment, I will be liable to pay the consultancy and visa cancelation service charges as per commitment & wait till the authorities cancel the visa.
D. I hereby declare, that I will be fully responsible if I resign my current job in India after applying for overseas employment and if for any reason
employer wants to cancel the visa, then that agency is not responsible, and the money expenditure on Government fees is not refundable.
E. I hereby declare, that I have read and understand the above and have been explained to me properly.
B.
Interview Remarks
'
0Accepted
:
0Rejected
Interviewer Name:
Signature:
Date:
Date:
30/08/2023
Signature:
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