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Page 1 of 18 U.A.P.G.M.E.E. - 2015 UTTARAKHAND AYURVEDIC POST GRADUATE MEDICAL ENTRANCE EXAMINATION - 2015 INFORMATION BROCHURE & APPLICATION FORM UTTARAKHAND AYURVED UNIVERSITY HARRAWALA, DEHRADUN Tel Phone : 0135-2685124 FAX : 0135-2685137 Website: www.uau.ac.in Email : [email protected]

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  • Page 1 of 18

    U.A.P.G.M.E.E. - 2015

    UTTARAKHAND AYURVEDIC POST GRADUATE MEDICAL ENTRANCE EXAMINATION - 2015

    INFORMATION BROCHURE

    &

    APPLICATION FORM

    UTTARAKHAND AYURVED UNIVERSITY

    HARRAWALA, DEHRADUN Tel Phone : 0135-2685124 FAX : 0135-2685137

    Website: www.uau.ac.in Email : [email protected]

  • Page 2 of 18

    EXAMINATION SCHEDULE AT A GLANCE

    Date of availability of application forms : 20-02-2015

    Last date to download application forms : 20-04-2015

    Last date of Submission of Downloaded Application forms : 25-04-2015

    Date of Examination : 24-05-2015

    Date of declaration of final result : 30-05-2015

  • Page 3 of 18

    Admission Notice For Media (Uttarakhand Ayurvedic P.G. Medical Entrance Examination-2015)

    As per the G.O. of Ayush Education Department, Govt. of Uttarakhand, Uttarakhand Ayurvedic P.G. Medical Entrance Examination-2015 is scheduled to be held on 24th May, 2015 at Dehradun center only. Candidates, who have passed their BAMS examination from any recognized Ayurvedic college in the country, are eligible for the entrance examination. The candidates can download the application forms and submit the required fee of Rs 3500/- (for General and OBC candidates) and Rs. 2500/- (for SC/ST/PH candidates) through on line bank challan and get a print out of on line application form and send it to Coordinator UAPGMEE- 2015 Uttarakhand Ayurved University, Harrawala, Dehradun- 248001 with the duly filled application form. The last date of submission of the application forms is 25-04-2015. For more details visit University website: www.uau.ac.in / Helpline No. +917895305763 (Coordinator) U.A.P.G.M.E.E.-2015 Copy to:- for information and necessary action. 1. P.S. to Hon'ble Vice Chancellor, Uttarakhand Ayurved University, Dehradun. 2. The Principal Secretary, Ayush Education Department, Govt. of Uttarkhand, Dehradun. 3. Director, Ayurvedic & Unani Services, Uttrakhand Dehradun. 4. Director Campus, Rishikul Ayurved University Campus College, Haridwar. 5. Principal, Uttaranchal Ayurvedic College, Dehradun. 6. Principal, Hamalaya Ayurvedic College, Doiwala, Dehradun. 7. Account Officer/ Finance Officer, Uttarakhand Ayurved University, Dehradun. 8. Examination Section. 9. Guard File. (Coordinator) U.A.P.G.M.E.E.-2015

  • Page 4 of 18

    UAPGMEE-2015

    Downloaded application form

    Completed application form should reach the Coordinator (U.A.P.G.M.E.E.2015),

    Uttarakhand Ayurved University, Harawala, Dehradun by registered post/speed post

    Uttarakhand Ayurved University, Harawala, Dehradun on or before 5:00 PM latest by 25-04-2015.

  • Page 5 of 18

    UTTARAKHAND AYURVED UNIVERSITY UTTARAKHAND AYURVEDIC POST GRADUATE MEDICAL ENTRANCE EXAMINATION

    (U.A.P.G.M.E.E.-2015)

    ADMISSION NOTIFICATION

    In compliance to Uttarakhand State GO No: 773/XXXX/2013-50/2011 dated 25-04-2013, Uttarakhand Ayurved University, Dehradun will conduct the competitive Entrance Examination on 24-05-2015 for admission to MD/MS(Ayurved) courses in Rishikul Ayurved University campus, Haridwar, Uttaranchal Ayurvedic College, Dehradun and Hamalayiya Ayurvedic College, Doiwala, Dehradun for the year 2015. For MD/MS (Ayurved) courses The competitive Entrance Examination shall be open to such candidates who: a) Have passed the BAMS Examination from any Ayurvedic College recognized by Central Council of

    Indian Medicine (CCIM) New Delhi.

    b) Are Registered with any State/Central Council of Indian Medicine (CCIM) New Delhi.

    c) Have completed rotatory Compulsory Internship on or before 31st October, 2015. d) *No of seats in different disciplines and position of reservation is given below.

    Sr. No. Subject Total No. of Seats

    For Uttarakhand seats

    For Other state seats

    Rishikul Ayurved University Campus, Haridwar (Uttarakhand) 1 Ras Shastra evam Bhaishajya

    Kalpna 07 02 General

    01 SC 01 OBC

    01 General 01SC 01OBC

    2 Panch karma 05 02 General 01 SC

    01 General 01 OBC

    3 Shalya Tantra 05 01 General 01 SC

    01 General 01 OBC 01 ST

    4 Dravyaguna 04 01 General 01 SC

    01 General 01 ST

    5 Kayachikitsa 04 01 General 01 ST

    01 General 01 SC

    6 Prasuti & Striroga 04 01 General 01 OBC

    01 General 01 SC

    7 Shalakya Tantra 04 02 General

    01 General 01 OBC

    Uttaranchal Ayurvedic College, Dehradun 8 Dravyaguna 02 01 General

    01 General

    9 Maulik Siddhant 02 01 General

    01 General

    10 Swasthavritta 03 01 General

    01 General 01 OBC

    11 Agadatantra 03 01 OBC 01 General

    01 General

    Hamalayiya Ayurvedic College, Doiwala, Dehradun 12 Dravyaguna 03 01 General

    01 SC 01 General

    13 Kriya sharir 03 01 General

    01 General 01 OBC

    14 Rachana sharir 03 01 General 01 OBC

    01 General

    15 Panch karma 03 01 General 01 SC 01 OBC Total 55 28 27

    * Entrance Test for these seats is subject to the approval of C.C.I.M/Government of India.

  • Page 6 of 18

    Examination fee and last date of receipt of completed application form/OMR:-

    1- Rs 3500/- for General and OBC Category 2- Rs. 2500/- for ST/ SC/PH Candidates

    a. The candidates will be provided original admit cards by speed post at their respective addressess.

    Duplicate admit card can be obtained from respective examination centre a day prior to the fix date of examination as well as one hour before on the date of the examination by depositing Rs.500/-. Complete details of examination are given in admission brochure and can also be downloaded from University website: www.uau.ac.in.

    b. Those candidates, who submit downloaded application forms, have to submit the required fee of Rs. 3500/- only (for General and OBC candidates) and Rs 2500/-only (for SC/ST/PH candidates)through on line bank challan and copy of original bank challan will be submitted with the application form. The last date of submission of the application forms to the Coordinator- (U.A.P.G.M.E.E.-2015) Uttarakhand Ayurved University, Harrawala, Dehradun is 25-04-2015 up to 5:00PM by registered/speed post.

    c. Duly filled application form will only be accepted along with prescribed examination fee. Those candidates, who are applying through the downloaded application forms, should submit completed application along with the fee in the form of on line bank challan and get a print out of on line application form and send it to Coordinator UAPGMEE- 2015 Uttarakhand Ayurved University, Harrawala, Dehradun- 248001.

    d. Completed application form should reach the Coordinator (U.A.P.G.M.E.E.2015), Uttarakhand Ayurved University, Harawala, Dehradun by registered post/speed post Uttarakhand Ayurved University, Harawala, Dehradun on or before 5:00 PM latest by 25-04-2015.

    (IV) Schedule of examination: (Please see second page of Brochure)

    Date of availability of application forms : 20-02-2015 Last date to download application forms : 20-04-2015 Last date of submission of Application form (By Post) : 25-04-2015 Centre of Examination : Dehradun Date of Examination : 24-05-2015 Date of declaration of final result : 30-05-2015

  • Page 7 of 18

    Uttarakhand Ayurvedic Post Graduate Medical Entrance Examination-2015

    (U.A.P.G.M.E.E.-2015)

    FOR ADMISSION TO

    POST GRADUATE AYURVEDIC DEGREE i.e. MD/MS (Ayurved) IN RISHIKUL UNIVERSITY CAMPUS HARIDWAR, UTTARANCHAL

    AYURVEDIC COLLEGE, DEHRADUN AND HIMALAYIYA AYURVEDIC COLLEGE DOIWALA, DEHRADUN.

    INFORMATION BROCHURE AND APPLICATION FORM (Information and Instructions to the candidates and to be retained by the applicant)

    1. GENERAL

    (i) As per Government of Uttarakhand GO No: 773/XXXX/2013-50/2011 dated 25-04-2013, Uttarakhand Ayurved University, Dehradun, will conduct the Competitive Entrance Examination for admission to MD/MS(Ay) Ras Shastra Evam Bhaishajya Kalpna, Shalya Tantra, Panch karma, Maulik Siddhant, Swasthavritta, Dravyaguna, Agadatantra, Prasuti Evam Striroga Shalakya, Kayachikitsa, Kriya sharir and Rachana sharir.

    (ii) Seats are available in RISHIKUL UNIVERSITY CAMPUS HARIDWAR, UTTARANCHAL AYURVEDIC

    COLLEGE, DEHRADUN AND HIMALAYIYA AYURVEDIC COLLEGE DOIWALA, DEHRADUN for the Academic year 2015.

    (iii) The competitive entrance examination for MD/MS (Ay) Ras Shastra Evam Bhaishajya Kalpna, Shalya Tantra, Panch karma, Maulik Siddhant, Swasthavritta, Dravyaguna, Agadatantra, Prasuti evam Striroga, Shalakya, Kayachikitsa, Kriya sharir and Rachana sharir shall be conducted for 55 seats out of which 28 seats shall be filled by those candidates who are domicile of Uttarakhand or Passed BAMS from Uttarakahnd and 27 seats shall be filled by the candidates from other States. These seats of MD/MS (AY) are subject to the permission for admission from CCIM/Govt. of India.

    (iv) The eligible candidates who get selected through U.A.P.G.M.E.E. 2015 will be given admission on

    available seats in post graduate courses by counseling on merit cum choice basis.

    (v) A candidate who is already admitted to any post graduate course will not be eligible to appear in the U.A.P.G.M.E.E. 2015 till he/she completes the course and passes the examination.

    (vi) The Entrance Examination, for admission to all these courses for 2015, will be held on 24-05-2015.

    at Dehradun.

    (vii) The MD/MS (Ayurved) course shall be of 3 year duration.

  • Page 8 of 18

    3. ELIGIBILITY CRITERIA For MD/MS (Ayurved ) courses Ras Shastra Evam Bhaishajya Kalpna, Shalya Tantra, Panch karma, Maulik Siddhant, Swasthavritta, Dravyaguna Agadatantra, Prasuti evam Striroga Shalakya, Kayachikitsa, Kriya sharir and Rachana sharir :- The competitive Entrance Examination shall be open to such candidates who:-

    (a) Have passed B.A.M.S. course from any Ayurvedic College recognized by Central Council of Indian

    Medicine (CCIM) New Delhi.

    (b) Are Registered with any State/Central Council of Indian Medicine (CCIM) New Delhi.

    (c) Have completed/will be completing Rotatory Compulsory Internship by 31st October, 2015.

    4. SCOPE OF EXAMINATION, EVALUATION & ELIGIBILITY FOR ADMISSION to MD/MS (Ayurved) :-

    (i) The Competitive Entrance Examination for MD/MS (Ayurved ) shall consist of one paper of 100 multiple answer questions. It shall be of three hours duration and shall carry maximum of 100 marks. Syllabus of the question paper shall be same as course of B.A.M.S. (All Professionals/year).

    (ii) All the questions will be objective type with multiple (A,B,C,D) choice of which only one will be the most appropriate response and, therefore, the correct choice. Each answer with correct choice shall be awarded ONE mark. ZERO marks shall be given to no response. 0.25 marks shall be deducted for each wrong response. If more than one choice is indicated against a question it shall be considered as incorrect response and 0.25 marks will be deducted for each such incorrect response.

    (iii) Answering Method: Read the instruction of OMR Answer sheet carefully. (iv) Minimum marks criteria: General Category candidates shall have to secure a minimum of 50% marks

    and the reserved category candidates a minimum of 40% marks in order to qualify for admission to a Post Graduate Ayurvedic course.

    (v) Candidates eligible in the reserved category will be given admission as per rules of State Government/

    Central Government applicable as on last date fixed for receipt of application. 5. APPLICATION FORM (i) Application forms/brochures will be made available at University website: www.uau.ac.in from

    20-02-2015 for download. (ii) Candidates are required to download application form from University website and will have

    to deposit their fee through online bank challan and send it along with the completed application form to the undersigned.

    (iii) A candidate seeking admission through the competitive entrance examination is required to send his / her application on the prescribed application format, which can be downloaded from the website: www.uau.ac.in completed in all respect to the office of Coordinator ( U.A.P.G.M.E.E.-2015), Uttarakhand Ayuerved University, Harrawala, Dehradun- 248001.

    (iv) A candidate should not fill in more than one form for the U.A.P.G.M.E.E.-2015. (v) Before filling up the application form, the candidate must familiarize himself/herself with the

    information given in this brochure. (vi) Every detail must be filled in by the candidate in his / her own handwriting. All answer must be given

    in words and not by dashes or dots. No column should be left blank. Where a column is not applicable, mention NA.

    (vii) Incomplete application form and form without examination fee {As explained in para-(ii), (iii) above} in the form of Bank challan, shall be rejected.

  • Page 9 of 18

    (viii) Candidate must affix latest passport size photographs in the space provided on the application form. The candidates who have completed their internship can get their photographs attested by a Gazetted Officer. Those who are still pursuing their internship program shall get their photograph attested by the Dean/Principal of their respective institution along with the certificate mentioning expected date of completion of internship, latest by 31st October, 2015. Candidates must bring one passport size photograph and one post card size photograph duly attested by Dean/Principal of their respective institutions in examination hall, failing which photography will be done by authorities at examination centre and Rs. 100/- will be charged for each photograph from the candidates.

    (ix) Furnishing of false information or suppression of any information would disqualify the candidate from the competitive entrance examination/admission and cancellation of admission if already admitted. If considered necessary, legal action may also be initiated against such candidate.

    (x) Application form of the candidates, who are likely to complete internship on or before 31st October, 2015 for MD/MS (Ayurved) course has to be countersigned by the Dean/Principal of Ayurvedic College from where the candidate has passed the B.A.M.S.. Examination in the forwarding note column.

    (xi) Candidate employed elsewhere must give a no objection certificate signed by the employer for appearing in the entrance examination failing which the application shall be rejected.

    6. COMPETITIVE AYURVEDIC POSTGRADUATE MEDICAL ENTRANCE EXAMINATION, 2015

    (i) The Postgraduate Ayurvedic medical entrance examination of 2015 will be held on 24-05-2015 at Dehradun centre.

    (ii) Admit Card list of eligible/non eligible candidates will be uploaded on University website and admit card of the eligible candidates will be sent to their respective address by speed post latest by 10th may 2015. The (Coordinator, UAPGMEE-2015) Uttarakhand Ayurved University, Dehradun shall not be responsible for non-receipt of admit cards due to any reason. Admit Card will not be sent to ineligible candidates and no correspondence in this regard shall be entertained nor shall their fees be refunded.

    (iii) However, if due to any reason the candidate fails to receive the Admit Card. The candidates will be given duplicate admit card at their respective examination center by depositing Rs. 500/- one day before (23.05.2015) and up to one hour before the starting of examination(24.05.2015). Such candidates must bring one attested copy of the same photograph, which he/she affix in the application form. For information regarding examination centre or any other Quarry the candidate can visit University website www.uau.ac.in .

    (iv) Entry to the Examination hall will be restricted to candidates producing the admit card, issued by the Coordinator (U.A.P.G.M.E.E.-2015), Uttarakhand Ayurved University, Dehradun or Competent Authority of examination Centre.

    (v) Examination will be held at Dehradun on 24-05-2015. Details of timing and venue will be

    communicated through University website and admit card to the candidates. (vi) Candidates must reach their center at least 30 minutes before the commencement of the examination.

    No candidate will be allowed at the examination center 15 minutes after the commencement of the examination.

    7. RESULT AND SELECTION CRITERIA:-

    (i) Candidates who secure a minimum of 50% marks in case of General Category and 40% marks in case of Reserved Category in the U.A.P.G.M.E.E.-2015 shall be eligible for admission to Post Graduate Ayurvedic Courses subject to availability of the seats through counseling.

    (ii) In case of candidates obtaining equal marks, merit will be determined in order of preference as under:

    (a) Candidates scoring less negative marks. If obtained equal marks then.

  • Page 10 of 18

    (b) Candidate obtaining higher average aggregate percentage of marks in all professional exams. If

    obtained equal marks then.

    (c) According to age i.e. older getting preference over younger.

    (iii) Merit list (combined & category wise) of eligible candidates for admission to the Post Graduate Ayurvedic courses shall be declared/published by the Coordinator (U.A.P.G.M.E.E.-2015), Uttarakhand Ayurved University, Harawala, Dehradun on website www.uau.ac.in and shall be displayed at the Office of the Coordinator (U.A.P.G.M.E.E.- 2015), Uttarakhand Ayurved University, Harawala, Dehradun.

    (iv) The allotment of course to the eligible candidates shall be made by the Counseling Board under chairmanship of Honorable Vice- Chancellor on personal appearance, along with all original documents as per his/her merit and choice of the course. The date and place of counseling shall be notified through website www.uau.ac.in. No intimation will be sent to the candidate by post. It will be the responsibility of the candidates to check these dates and appear for counseling and allotment of course. The candidate will have to deposit a fee of Rs. 5000/- at the time of counseling thorough on line bank challan. All available seats in different courses shall be displayed along with its recognition status at the time of counseling. The candidate may choose any one of the available seats according to their merit. A seat once allotted to candidate for any course shall be final.

    (v) Rs. 25000/- will have to be deposited by the candidates as advanced tuition fee after allotment of seat. Candidates are allowed to appear for re-counseling only after depositing Rs. 5000/- Counseling registration fee. Those candidates who failed to take admission after allotment of seat, his/ her advanced tuition fee will be forfeited. Those candidates who wish to withdraw admission , he/she will have to deposit entire course fee at the University. All the fee will be deposited through bank challan.

    (vi) If seats remain vacant after last round of counseling than these vacant seats will be filled as follows.

    (a) OBC category vacant seats will be filled by general category students. (b) If seats of schedule caste/schedule tribe categories remains vacant than these seats will be filled by

    interchanging. If further remains vacant than these seats will be filled by OBC category students and if ample number of OBC category students are not available than these seats will be filled by general category students.

    8. ADMISSION Admission of the candidates shall be made by the Director Campus Rishikul Ayurved University Campus, Haridwar, Uttaranchal Ayurvedic College, Dehradun and Himalayiya Ayurved College, Doiwala , Dehradun. (i) A candidate who had qualified for admission to a postgraduate course shall have to deposit the

    prescribed fee on the date notified for the purpose by the University. Those who fail to do so will loose their claim for admission in the course.

    Admission in MD/MS(Ayurved) course shall be given only after the candidate produces following original documents at the office of Director Campus Rishikul Ayurved University Campus, Haridwar, Uttaranchal Ayurvedic College, Dehradun and Himalayiya Ayurved College, Doiwala , Dehradun.

    (a) High School certificate as proof of date of birth. (b) Original Mark sheets of all professional Examination. (c) B.A.M.S. passing out certificate or degree. (f) Employers relieving certificate, if employed. (d) Compulsory Rotatory internship completion certificate. (e) Permanent Registration Certificate of Indian Medicine Board (g) S.C./S.T./O.B.C/PH Certificate, if applicable. (h) Allotment letter, issued by Chairman, Counseling Board of U.A.P.G.M.E.E.-2015.

  • Page 11 of 18

    (i) Admit Card of U.A.P.G.M.E.E.-2015. (j) Score Card of U.A.P.G.M.E.E.-2015. (j) Domicile certificate on prescribed Performa.

    (ii) Candidates shall be required to complete the admission formalities and join the course assigned to

    them within specified period notified by the University. (iii) At the time of counseling reservation policy will be applicable as per order of the Govt. of

    Uttarakhand / Govt. of India. (iv) After allotment of the seats candidates who failed to join the course within the specified period shall

    forfeit the right of admission and the security fee. 9. APPLICATION FORM SHALL ACCOMPANY THE FOLLOWING DOCUMENTS:

    Completed on line Application forms must be accompanied with the checklist provided below. (a) Attested photocopy of High School pass certificate as proof of date of birth. (b) Attested photocopy of the mark sheets of all the three professional examinations of B.A.M.S. (c) Attested photocopy of the compulsory rotatory internship certificate.

    (d) Attested photocopy of provisional/permanent registration Certificate of Indian Medicine Board.

    (e) Eligible candidates belonging to reserve category, must submit a certificate on the attached

    Performa certified by any competent authority. In case the certificate is not as per prescribed Performa the benefit of reservation shall not be allowed.

    (f) Attested photocopy of B.A.M.S passing out certificate. (g) Any other certificate. (h) On line Bank Challan of Rs. 3500/- ( For General and OBC Candidates) and Rs. 2500/- (for

    SC/ST and PH candidates), along with downloaded application forms. (i) Domicile certificate: Candidate shall submit their domicile Certificate.. (j) No Objection Certificate if employed.

  • Page 12 of 18

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  • Page 15 of 18

    UTTARAKHAND AYURVED UNIVERSITY

    UTTRAKHAND AYURVEDIC POST GRADUATE MEDICAL ENTRANCE EXAMINATION-2015

    For Admission to Post Graduate Course MD/MS (Ayurved) APPLICATION FORM

    (Incomplete application will not be entertained)

    1. Name: ..

    (As per High School certificate not to be include Mr./Mrs./Miss. Dr.)

    2. Fathers Name: .

    3. Mothers Name: .

    4. Nationality:

    5. Date of Birth: .

    (Attach attested photocopy of High School certificate)

    6. Place of Birth: State ..

    7. Mark of Identification: ..

    8. Whether SC/ST/OBC (if yes, attach certificate from competent authority):

    9. Full mailing Address (with pin code for correspondence):

    ..

    Tel / Mob

    E-Mail address: .

    10. Permanent Address (with Pin Code):

    ..

    .

    11. Present Job/Service (if any):

    12. School/College Examination passed (attach attested photocopy of mark sheets)

    Examination Institution Subjects Year of admission

    Year of passing

    High School Intermediate/10+2 Any Other

    13. Professional Examination passed (attach attested photocopy of mark sheet of all the examination) Class Institution Marks Month and Year

    of Passing Maximum Obtained Percentage B.A.M.S. 1st Professional

    B.A.M.S. 2nd Professional

    B.A.M.S. Final Professional

    Grand Total

    Affix Photograph duly

    attested by Principal of the Institute from which he/she passed

    B.A.M.S. examination/Gazetted

    officer

  • Page 16 of 18

    14. Date of Completion of Compulsory Rotatory Internship (attach attested photocopy) 15. Details of the B.A.M.S. Entrance Examination:-

    (a) Name of Entrance Examination:

    (b) Year of Entrance Examination:

    (c) Conducting body:

    (d) Roll number:

    16. Registration (attach attested photocopy)

    Name of Board/ Council Registration No

    17. Mention year-wise account of time gap from completion of internship till submission of application

    for U.A.P.G.M.E.E. 2015 From To Details

    Course Job Assignment

    18. Category (tick applicable) Sub category applicable General ST AFS PH SC OBC FF Women 19. Details of On line Bank challan Enclosed (with downloaded application forms)

    Rs. 2500/- For SC/ST Category: Rs. 3500/- For General/OBC Category: Bank Challan No. Date

    AmountBank Name....

    Issuing Branch.

    20. Details of present employment, if any:

    Name and full address of the Employer

    Post held with date

    Nature of appointment

    Tenure of appointment (for Temporary employees)

    Date:.. Signature of Candidate

  • Page 17 of 18

    DECLARATION BY THE APPLICANT

    (a) That IS/D/of ..resident of (permanent address).. Hereby declare that I am not studying in postgraduate course in any Ayurvedic/Medical College of India.

    (b) That I hereby declare that the above application has been filled in my own hand-writing and the information given by me in the application form is correct and nothing has been concealed. In case, at any stage it is found that information furnished by me is false, I shall have no claim to admission and if already admitted, my admission shall be cancelled.

    (c) That I further declare that, I shall abide by the rules governing the course as laid down by the University and the Institution providing the course.

    (d) That I am presently not employed/employed with It is further known to me that in case of any dispute the decision of the authorities of the University shall be final and binding on me and shall also submit NOC from employer and competent authority.

    (e) That I am domicile of Uttarakhand and/or was admitted in (College). (State).....

    (f) That I have not filed any petition in any court of law related to my admission through previous UAPGMEE examination.

    (g) That I have filed a petition number. in.. Court and I will withdraw my petition, if course is allotted to me on the basis of U.A.P.G.M.E.E. 2015.

    Signature of Parents/Guardian Signature of Candidate Date:.

    21 APPLICATION FORM CHECKLISTS:

    Completed On line Application forms must be accompanied with the checklist provided below appropriately marked right. (a) Attested photocopy of High School pass certificate as proof of date of birth. (b) Attested photocopy of the mark sheets of the professional

    Examinations of B.A.M.S. (c) Attested photocopy of provisional / permanent l registration Of the Indian Medicine Board. (d) Attested photocopy of the compulsory rotatory internship certificate. (e) Eligible candidates belonging to reserve category, must submit a Certificate on the attached Performa certified by any competent authority. In case the certificate is not as per prescribed Performa the benefit of Reservation shall not be allowed.

    (f) Attested photocopy of B.A.M.S. passing out certificate. (g) Any other certificate.

    (h) Original Copy of On line Bank Challan of Rs. /- (Challan No. ..)

    (i) Domicile certificate: Domicile Certificate on Prescribed Performa. (j) No Objection Certificate of employer if employed.

    Date: ..

    Signature of Candidate

  • Page 18 of 18

    Forwarding note by the principal (Only for those who are pursuing internship)

    (a) Dr.has passed the B.A.M.S examination from this Institution in academic year

    (b) The candidate has already finished his/her compulsory rotatory internship on dated------------------ or is expected to complete internship by..

    Date: Signature with Seal of the Dean/Principal of the institution

    (To be filled in by the Head of the Department/Employer)

    ENDORSEMENT BY THE HEAD OF THE DEPARTMENT/EMPLOYER UNDER WHOM THE CANDIDATE IS PRESENTLY WORKING

    Dr. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..is working under me as . . . . . . . . . .

    . . . . . . ..... for the last. .. . . . Months/years. To the best of my knowledge, the information furnished by

    the candidate in the application form is correct. I have no objection in his/her seeking admission to the

    MD/MS (Ay) course. If he/she is admitted he/she will be relieved for three years for undergoing the course.

    Date: Signature of the Employer With Designation & Seal

    (To be filled in by the Head of the Department/Employer)

    FORWARDING NOTE TO BE SIGNED BY THE COMPETENT AUTHORITY OF THE ORGANIZATION IN WHICH THE CANDIDATE IS EMPLOYED (IF APPLICABLE)

    I certify that this application made by Dr. ----------------------------------------S/o -------------------

    -------------------------------is being made with my consent and permission and that he/she will be immediately

    relieved, if selected for the course.

    Signature of the competent authority/Employer

    With Designation & Seal