ANNEXURE – I
Sl.
No Arrange the following documents in the given sequence only
For GENERAL and NRI
1 Duly signed application form /Registration copy of information.
(Kindly click the link and provide the online information)
Medical (MD/MS/DOMS) https://jnmc.contineo.in/admission/
.
2 Provisional Allotment Letter issued by MCC
3 Admit Card issued by NBE
4 Result/Rank Letter issued by NBE
5 10th / SSLC Standard / Equivalent Marks Card (For date of birth).
6 12th /PUC standard Marks Card of the Candidate
7 MBBS marks card issued by Universities of all phases/years.
8 Degree Certificate / Provisional Certificate
9 Migration Certificate from the Concerned University if MBBS done from other than
KLE Academy of Higher Education and Research, Belagavi
10 Internship Completion Certificate.
11 Permanent State / Central Medical / Dental Council Registration Certificate to be compulsorily
submitted at the time of admission process.
12 Six recent passport size colored photographs with name and date.
13 Caste certificate (OBC/SC/ST) (in English version)
14 EWS Certificate as per the Central Govt. Norms (if applicable)
15 Certificate of Domicile
16 Fee remittance copy/ acknowledgement / Demand Drafts (of Nationalized / Scheduled Bank) for fees
17 Photo Copy of PAN CARD (Candidate & Parent)
18 Photo Copy of Aadhaar Card (Candidate & Parent)
19 NBE Screening test & NMC registration certificate (qualified MBBS other than India)
Annexure – I (List of documents)
Annexure – II (Undertaking/Bond)
Annexure – III (Service bond)
20 Other documents:
Anti-ragging undertaking by students and parents/guardians.
(This has to be submitted online on or before commencement of course). www.antiragging.in
21 Mandatory Documents submission by NRI/Foreign Candidates :
NRI / NRI ward/ OCI / PIO / Foreign Nationals Candidates:
a) Candidate's parents resident certificate issued by the Embassy of that country
complying with the Income Tax Rules / any other certificates to establish evidence that
they are resident of that country / affidavit on Rs.100/- e-stamp paper to that effect.
b) Candidate's passport / VISA / Resident VISA.
c) Citizenship of the candidate.
d) Income Tax Documents required as per the Income Tax Act 1961.
e) If NRI Ward - with Ward Certificate.
f) If candidate is foreign medical graduate must submit screening test certificate.
g) Candidate’s Study certificate for having studied outside India where applicable for the
qualifying examination. Note: For the purpose of verification e-document may be
considered with regard to NRI ward certificate subject to submitting the original at the
time of taking the admission.
For Foreign Nationals :
a. Foreign national’s qualification registration certificate by the corresponding Medical
Council or concerned authority in his / her own country from where he / she has
obtained his / her basic medical graduate qualification.
b. Obtain Temporary registration certificate from MCI/DCI within one month of securing
admission.
c. Indian/OCI citizen who have obtained their Medical Qualification outside India must
submit original Screening test pass certificate & MCI registration certificate.
Mandatory Other documents as prescribed in MCC website:
1. Affidavit of the person who is NRI and the sponsorer.
2.Documents claiming that the sponsorer is an NRI (Passport, Visa of the sponsorer)
3.Relationship of NRI with the candidate as per the court orders of The Hon’ble Supreme
Court of India in case W.P.(c) No. 689/2017-Consortium of Deemed Universities in
Karnataka (CODEUNIK) & Ans. Vs Union of India & Ors. dated 22-08-2017
4. Affidavit from the sponsorer that he/ she will sponsor the entire course fee of the candidate
duly notarized.
5.Embassy Certificate of the Sponsorer.(Certificate from consulate)
6. Passport copy of the Candidate
Note: Candidates without original certificates/documents shall not be given admission in allotted
Medical/Dental College. Candidates who have deposited their original documents with any other
Institute/College/University and come for admission with a certificate stating that "their original
certificates are deposited with the Institute/College/ University” shall not be given admission in
allotted Medical/Dental College.
ANNEXURE – II
MEDICAL (MD/MS/PG DIPLOMA) course
DISCONTINUATION BOND FORMAT
UNDERTAKING for General / NRI
(to submit the bond on stamp paper of Rs.200/- Notarized)
I, Mr/Ms…………………………………………….. (Name of the Candidate), aged
about……years, S/D/o…………………………..(Name of the Parents resident of
…………………………………(Permanent/present address of Parent) do hereby swear an oath as
follows:
I, have been selected to the 1st year Medical (MD/MS/PG DIPLOMA) course at
Jawaharlal Nehru Medical College, Belagavi, a constituent college of KLE Academy of
Higher Education & Research, Deemed-to-be University under Section 3 of the UGC Act 1956
through the Common Counseling conducted by the Directorate General of Health Services
(DGHS), Government of India, New-Delhi through NEET PG Rank No……………………...
In consideration of admission to 1st year Medical (MD/MS/PG DIPLOMA) course, I
shall complete the (MD/MS/PG DIPLOMA) course and accordingly undertake to pay all the
tuition and other fees as per University Norms.
In the event of my discontinuation of (MD/MS/PG DIPLOMA) course due to any reason,
I along with my parent /guardian hereby undertake to pay balance tuition and other fees
University, Belgaum payable for the entire course without any demur.
I have executed this affidavit in sound mind, out of free will without any force or coercion
to either sign or execute this Affidavit.
Signature of the Candidate Signature of the Parent/Guardian
VERIFICATION
This is to verify that the contents of this affidavit are true to the best of my knowledge, information and belief.
Verified at ……………………on this the day of …………... 2022.
Identified by me
Advocate DEPONENT
No. of corrections.
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ANNEXURE – III
UNDERTAKING
(to submit the bond on stamp paper of Rs.100/- Notarized)
Herein, I Dr. ___________________, Age: ____ Years, Resident of __________ do hereby
undertake as follows:
I have qualified through the NEET–Post Graduate-2021 for admission to MD/MS course
in _________ at the J.N. Medical College, Belagavi. The course duration is of three years.
I hereby undertake that I shall serve as Senior Resident at the Teaching hospital of
Jawaharlal Nehru Medical College or other Health Institutes of KLE Academy of Higher
Education and Research for a period of one year after completion of my course. I shall join service
immediately on completion of my course and serve for a minimum period of one year. The
Postings shall be at the discretion of the institution, depending on the vacancies. The undertaking
will be implied only in the presence of vacancies.
I further undertake that I shall submit my original certificates and testimonials such as
marks sheet, passing certificate, NEET qualifying certificate / Degree Certificate, etc. The said
documents shall be under the custody of the college authorities till the termination of this service.
In case I fail to serve for a period of one year, I undertake to pay a sum of
Rs. 10 Lakhs (Rupees Ten Lakhs Only) as damages for breach of assurance.
Name & Address of the Candidate Signature
Email Id of the candidate :
Witness Name : ______________________ Signature
Place: Date
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