brochure for 2016 17 - karwar institute of medical … required for...instructions for the students...

KARWAR INSTITUTE OF MEDICAL

SCIENCES, KARWAR

BROCHURE FOR 2016 – 17

INSTRUCTIONS FOR THE STUDENTS WHO ARE TAKING ADMISSIONS FOR

I-MBBS COURSE AT KARWAR INSTITUTE OF MEDICAL SCIENCES,

KARWAR ALLOTTED THROUGH KARNATAKA CET/ ALL INDIA QUOTA

1. Students must report in principal’s office at KAiMS for MBBS admission on or

before date indicated on their selection letter issued by K-CET / NEET AIQ before 10-00

am. If any student fails to report before last date indicated in the office letter, his / her

admission will stand cancelled and the same will be intimated to concerned authorities.

2. One of the parent / guardian must accompany students at the time of admission as certain

documents are to be signed by them.

3. The admission process is likely to take two days.

4. The admission offered to a candidate will be only provisional.

5. The students are instructed to keep the Xerox copies of the above original documents until

they are returned from Rajiv Gandhi University of Health Sciences, Bangalore.

6. The students are instructed to download all the below mentioned forms and must be

filled in by his / her own handwriting with blue or black point pen neatly and legibly in

English or computer typed in capital letters only, except for signature and submit the same

at the time of admission.

7. Overwriting, cutting, erasing in the form may lead to rejection and should be avoided.

Check thoroughly whether you have filled all your relevant details correctly in the

concerned forms.

8. Important: No forms / proforma will be issued at KAiMS office as they are made available

in KAiMS website.

9. Institute working hours: 10-00 am to 1.30 pm and 2.15 pm to 5.30 pm.

10. Each candidate must submit the following original certificates Shown below along with three

sets of attested true copies. The originals and Xerox must be produced in the following

sequence, failing to which there admission will be withheld and for that KAiMS will not be

held responsible.

Documents to be Produced: (Originals with 4 sets of Xerox copies) SL

NO PARTICULARS

1 Requisition letter addressed to the Principal, KAiMS, Karwar

requesting for MBBS admission (proforma given below)

2 Form-I and Form-II (proforma given below)

3 CET allotment order

4 CET marks card

5 Admit card / counseling letter / NEET results sheet (for AIQ Students)

6 Original challan for having paid college fee

7 10th marks card / 10th passing certificate


9 Students claiming reservation under Hyderabad-Karnataka region (article-371J) shall submit

eligibility certificate

10 Transfer certificate

11 Study certificate from the Institute last attended

12 Character and conduct certificates from the Institute last attended

13 Caste certificate

14 Income certificate

15 Domicile certificate (other than Karnataka students).

16 Eligibility certificate from RGUHS (for students other than Karnataka PU board)

17 Migration certificate from the University last attended (if Applicable)

18 Migration certificate from the board if passed 12th standard from the board (other than

Karnataka PU board)

19 Physical fitness certificate (Medical certificate)

20

Regional language and English translated caste certificates from eligible CET students to be

submitted during admission by SC/ST/CAT-I, 2a, 2b, 3a and 3b students who scored less than

50% and more than 40% marks in 10+2 (PCB) examination required for submission to MCI, New

Delhi.

21

Regional language and English translated caste certificates from eligible CET students to be

submitted during admission by SC/ST/CAT-I, 2a, 2b, 3a & 3b students who scored less than 50%

and more than 40% marks in entrance examination required for submission to MCI, New Delhi.

22 Annexure-I, Part-I:-Undertaking by the candidate/student - to be typed in Rs. 100/- E-stamp

paper and duly attested by notary (proforma given below).

23 Annexure I, Part II: - Undertaking by parent/ guardian - to be typed in Rs. 100/- E-stamp paper

and duly attested by notary (proforma given below).

24 Undertaking: - MBBS degree programme as per RGUHS curriculum - to be typed in Rs. 50/-E-

stamp paper. and duly attested by notary (proforma given below).

25 Rural service bond by candidates who select MBBS seats KAiMS, Karwar – to be typed in Rs.

100/- E-stamp paper and attested by a notary (proforma given below).

26

Four (04) recent color digital passport size photographs. The Photographs must indicate clearly

the name of the candidate along with the date of taking the photograph. Candidates must keep 8-

10 identical photographs ready in reserve for further use.

27 One single file with latest photograph affixed on it including name and address of the candidate.

REQUISITION LETTER FOR CET STUDENTS

To, Date:

The Principal, KAiMS, Karwar.

Sir,

Sub: - Request for admission to I Year MBBS course at KAiMS, Karwar allotted through Karnataka Common Entrance Test – reg.

Ref: - Provisional Allotment Letter of AIQ –UG Medical Online Allotment

Process Counselling-2016 Dated: ________________

Director KEA, Bangalore

-----

As per the letter cited under reference, I Mr. / Ms. ___________________________

S/o, D/o._________________________, bearing Admission Order No. ______________,

CET No._________ Rank No._________ who belong to _______ category has been

allotted MBBS seat at Karwar Institute of Medical Sciences, Karwar under ________

category.

I am herewith enclosing the original fee challan for having paid college fees along

with necessary original documents.

Hence, I request your kind self to admit me in your institute for I MBBS course on

my request and risk and I am aware that my admission is subject to the approval of the

concerned competent authorities, for which KAiMS, Karwar will not be held responsible

for any consequences / objections arise in future with regard to my admission.

Yours faithfully,

(Signature of the candidate) (Signature of the parent / Guardian) Place: Karwar

Date:

REQUISITION LETTER FOR AIQ STUDENTS

To Date:

The Principal, KAiMS, Karwar.

Sir, Sub: - Request for admission to I Year MBBS course at KAiMS, Karwar allotted

Through all India Quota – reg.

Ref: - Provisional Allotment Letter of AIQ-UG Medical Online Allotment Process _____ Counselling-2016 Dated: ______.

-----

As per the letter cited under reference, I Mr. / Ms. _________________________

S/o, D/o._________________________, bearing Roll No. _____________, AIQ Rank

No.________ who belong to _______ category has been allotted MBBS seat at Karwar

Institute of Medical Sciences, Karwar under ________ category.

I am herewith enclosing the original fee challan for having paid college fees along

with necessary original documents.

Hence, I request your kind self to admit me in your institute for I MBBS course on

my request and risk and I am aware that my admission is subject to the approval of the

concerned competent authorities, for which KAiMS, Karwar will not be held responsible

for any consequences / objections arise in future with regard to my admission.

Yours faithfully,

(Signature of the candidate)

(Signature of the parent / Guardian) Place: Karwar

FORM-I

KARWAR INSTITUTE OF MEDICAL SCIENCES, KARWAR TO BE FILLED BY THE CANDIDATES FOR OFFICE USE

(TO BE FILLED IN BLOCK LETTERS ONLY)

Sl.

No.

PARTICULARS INFORMATION TO BE FILLED

1 Name of the Candidate as per 10th Marks card.

2 Blood Group

3 Father’s Name :

Student's Permanent Address :

Phone No. (of Student and Parent/Guardian)

and Email Ids (of Student and

Parent/Guardian)

4 Sex

5 Caste Religion :

Caste :

Category :

6 Nationality

7

Allotment / Rank Details

CET NO : RANK :

AIQ : RANK :

8 Marks Scored in CET/AIQ

(Enclosed Details ) Exam

Passed

Max

Marks

Marks

Obtained

% of

Mark

s

CET

AIQ

Qualifying Exam

Register No in PUC / 12th Class

PUC / 12th Class Passed Year

Date Month Year

Specify the name of the University / Board

where you have studied PUC / 12th STD.

Total marks scored in optional subjects in

PUC / 12th Standard Max Marks Marks Obtained % of Marks

Physics

Chemistry

Biology

Total Marks

Marks scored in English subject in PUC 12th

standard subject in PUC /

Max Marks Marks Obtained % of Marks

Total marks scored in all subjects in PUC / 12th

Standard

9 Date of Birth (as per 10th marks card) DD/MM/YYYY :

10 Date of Admission Date: Month : Year :

11 Documents Enclosed (Yes/No)

Place :

Date :

Signature of the Candidate :

Signature of the Parent :

FORM-II

KARWAR INSTITUTE OF MEDICAL SCIENCES, KARWAR TO BE FILLED BY THE CANDIDATES FOR OFFICE USE

(TO BE FILLED IN BLOCK LETTERS ONLY)

Sl

No.

Particulars Information to be filled up

1 Allotment No. CET

AIQ

2 Date of admission

3 Name of the candidate

4 Father’s name (specify name of the guardian, if father is not

alive)

5 Occupation

6 Permanent address

7 Correspondence address

8 Income of the parent / guardian

9 Place of birth

10 Date of birth

11 Religion caste category (SC/ST/other category–please

specify)

12 Native district

13 Karnataka / non Karnataka

14 Name of the former school/college studied.

15 Qualifying exam passed

16 Whether vaccinated

17 College fees paid at the time of admission

18 Bank receipt no. & date :

Place: Karwar Signature of the candidate:

Date: Signature of the parent:

ANNEXURE I - PART I

UNDERTAKING BY THE CANDIDATE/STUDENT

1. I, ___________________________________________________________ S/o / D/o.

of Mr./Ms._________________________________________, have carefully read and

fully understood the law prohibiting ragging and the directions of the Supreme Court

and the Central/State Government in this regard.

2. I have received a copy of the MCI Regulations on Curbing the Menace of Ragging in

Higher Educational Institutions, 2009.

3. I hereby undertake that -

I will not indulge in any behavior or act that may come under the definition of

ragging

I will not participate in or abet or propagate ragging in any form,

I will not hurt anyone physically or psychologically or cause any other harm.

I hereby agree that if I found guilty of any aspect of ragging, I may be punished as per

the provisions of the MCI Regulations mentioned above and/or as per the law in force.

Signed this _____ day of ______________________ month of _________year

1. Witness (signature & address) Signature :-

Address:______________________

________________________________

________________________________

2. Witness (Signature & Address)

SEAL & SIGNATURE OF

THE GOVERNMENT NOTARY

TO BE TYPED IN RS.100/- E-STAMP PAPER

ANNEXURE I, PART II

UNDERTAKING BY PARENT/GUARDIAN

1. I,________________________________________________________ F/o /M/o / G/o

___________________________________________aged ________________ years,

working as ________________________________(occupation), Resident of

______________________________________________________________________

_______________________________________________________(correspondence

address) have carefully read and fully understood the law prohibiting ragging and the

directions of the Honorable Supreme Court and the Central/State Government in this

regard as well as the MCI Regulations on Curbing the Menace of Ragging in Higher

Educational Institutions, 2009.

2. I assure you that my son/ daughter will not indulge in any act of ragging.

3. I hereby agree that if he/she is found guilty of indulging in ragging, he/she may be

punished as per the provisions of the MCI Regulations mentioned above and/or as per

the law in force.

Signed this ____ day of____________________ month of ____________ Year

1. Witness (Signature & Address) ( )

Signature & address:

2. Witness (Signature & Address)

SEAL & SIGNATURE OF



UNDERTAKING

MBBS DEGREE PROGRAMME AS PER RGUHS CURRICULUM

I,_____________________________________________________ Son / Daughter of

______________________________________ (herein after called the Natural Guardian of the Student)

hereby given an undertaking that on admission to I MBBS at Karwar Institute of Medical Sciences,

Karwar, during the year 2016-17, read the rule No.11of the ordinance of Governing M.B.B.S. Degree

Programme of Rajiv Gandhi University of Health Sciences, Bangalore, vide Notification No. ACA/BOS-

27/97-98, dated: 24.03.1998, and I shall abide / by the ordinance.

That no student shall be permitted to join Phase-II (Para Clinical & Clinical) Group of subjects

until he / she pass in the Phase-I (pre-clinical) subject for which he / she will be permitted not more than

four chances (Actual Examination) provided four chances are completed within three years from the date

enrollment.

Signature of the student with full address

Witness:

1.

2.

SEAL & SIGNATURE OF



EXECUTION OF RURAL SERVICE BOND BY CANDIDATES WHO SELECT MBBS SEATS IN

KAiMS, KARWAR

I Mr./Ms._______________________, S/o. / D/o._______________________ a

Candidate with ‘CET / AIQ - 2016’ Admission Ticket No._______________ residing

at________________________________________________ have on my own volition

allotted a MBBS seat on ____________ In ______________

__________________________________vide admission order number_________ dated

___________ and do hereby undertake as follows.

In accordance with the Amendment to Rule 11 of the Karnataka Selection of

Candidates for Admission to Government seats in Professional Educational Institutions

Rules, 2006, vide Government Notification-1. No.HFW 79 RGU 2011 dated 17.07.2012, I

am prepared on completion of the course to serve in any Primary Health Center or Primary

Health Unit situated in Rural Areas in the State of Karnataka for a minimum period of

ONE year, failing which I render myself liable to pay a penalty of Rupees Ten

Lakhs to Government of Karnataka.

What is stated above is true and correct and I and my parent hereby undertake to act

accordingly.

SEAL & SIGNATURE OF THE GOVERNMENT NOTARY


Signature of the candidate Signature of the Parent

(Father / Mother)

Date : ____________

Place :____________

NO. KAiMS/ /UGS :_____ Office of the Director,

Karwar Institute of Medical sciences

Karwar

OFFICE MEMORANDUM

Sub: MBBS Phase –I admission through AIQ-2016reg.

Ref : DGHS –All India Quota 2016 Medical Counseling Committee,

New Delhi Online generated provisional seat allotment letter Dt:

Mr./Miss___________________ category___________________ Seat Allotted

Category___________ Merit/Rank No._______ Roll No.________ who has been

MBBS seat allotted during First /Second/Third AIQ-2016 counseling to Karwar

Institute of Medical sciences ,Karwar has been reported and provisionally admitted

to MBBS Phase-I on _____________subject to the approval of concerned

authorities. He /She has submitted all relevant originals certificates and testimonials

to this collage.

Principal,

Karwar Institute of Medical Sciences,

Karwar

To:

The Above Candidate

NO. KAiMS/ /UGS: _____ Office of the Director,

Karwar Institute of Medical sciences

Karwar

OFFICE MEMORANDUM

Sub: MBBS Phase –I admission through KEA Bangalore -2016reg.

Ref : KEA ,Bangalore online generated admission order No:

___________Dt________2016

Mr./Miss ______________________________KEA/CET No. ______ Rank

No : ________Category _________________ Who has been selected and allotted to

Karwar Institute of Medical Sciences, Karwar has been reported and provisionally

admitted to MBBS Phase-I on_________2016 subject to the approval of concerned

authorities. He/She has submitted all relevant originals certificates and testimonials to the

colleges.

Principal,

Karwar Institute of Medical Sciences,

Karwar

To: The Above Candidate.

INFORMATION TO BE FILLED UP BY KARNATAKA CET / ALL INDIA QUOTA STUDENTS

(STRIKE WHICHEVER IS NOT APPLICABLE) I, Mr. / Ms. ____________________________________________ has been selected to MBBS course through

KARNATAKA CET-2016 / ALL INDIA QUOTA and allotted to KAiMS, Karwar. I am herewith submitting a

requisition letter seeking for admission. My admission details are as follows:-

a) CET / AIQ Allotment No. and Date :

b) CET / AIQ Rank No. :

c) Category :

d) Allotted Category :

e) Last Date for admission :

LIST OF DOCUMENTS SUBMITTED BY Mr. / Ms. ----------------------------------------------------------------------------------------------------

SL

NO PARTICULARS SUBMITTED

NOT

SUBMITTED

NOT

APPLICABLE

1 Requisition letter addressed to the Principal, KAiMS, Karwar

requesting for MBBS admission

2 Form-i & form-II

3 CET allotment order

4 CET marks card

5 Admit card / counseling letter / NEET results sheet (for AIQ students)

6 Original challan for having paid college fee



9 Students claiming reservation under Hyderabad-Karnataka region

(article-371J) shall submit eligibility certificate

10 Transfer certificate

11 Study certificate from the institute last attended

12 Character & conduct certificates from the institute last attended

13 Caste certificate

14 Income certificate

15 Domicile certificate (for other state students)

16 Eligibility certificate from RGUHS (for students other than

Karnataka PU board)

17 Migration certificate from the university last attended (if applicable)

18 Migration certificate from the board if passed 12th standard from the

board other than Karnataka PU board

19 Physical fitness certificate (Medical Certificate) 20 Regional language and English translated caste certificates to be

submitted by SC/ST/CAT-I, 2a, 2b, 3a & 3b students who are eligible

for admission with less than 50% and more than 40% marks in 10+2

(PCB) examination required for submission to MCI. 21 Regional language & English translated caste certificates to be

submitted by SC/ST/CAT-I, 2a, 2b, 3a & 3b students who are eligible

for admission with less than 50% and more than 40% marks in

entrance examination required for submission to MCI

22 Annexure I, part I: -undertaking by the candidate/ student - to be typed

in Rs. 100/- E-stamp paper.

23 Annexure I, part II: - undertaking by parent/ guardian - to be typed in

Rs.100/- E-stamp paper.

24 Undertaking:- MBBS degree programme as per RGUHS curriculum

- to be typed in Rs. 50/- E-stamp paper.

25 Execution of rural service bond by candidates who select MBBS seats

in KAiMS, Karwar– to be typed in Rs. 100/- E-stamp paper.

26

Four (04) recent color digital passport size photographs one single

file with latest photograph affixed on it including name and address

of the candidate

Place: Karwar Signature of the Candidate: Date: Signature of the Parent:

Note:

1. Students admitted to this institute are expected to strictly follow the code of discipline.

2. Drinking alcohol, smoking or consuming any intoxicants by students is strictly prohibited.

3. Ragging in any form is punishable by law. An undertaking to this effect signed by the

candidate and his/her parent /guardian as shown above must be submitted at the time of

admission compulsorily.

4. Candidates are advised to keep a printed copy of their completed application form along with

forms for their record and future reference.

5. No management quota seats are available in KAiMS, Karwar

Sd/-

Director,

KAiMS, Karwar.

CONTACT DETAILS

PHONE : 08382-226650

FAX : 08382-220364

WEBSITE : www.kimskarwar.kar.nic.in

EMAIL : [email protected]

ADDRESS : Karwar Institute of Medical Sciences, Karwar

M.G. Road, Karwar (U.K) - 581301

MBBS ADMISSION FOR THE ACADEMIC YEAR ………….

Admin No. ……….

(For office use only)

1. STUDENT NAME: ………………………………………..

(Capital letters only) Photo

2. COURSE : MBBS

3. DATE OF BIRTH: …………………………………………

4. BLOOD GROUP: …………………………………………

5. RESIDENTIAL ADDRESS: …………..…………………………………………

…..…………………………………………………………………………………

………………………………………………………………………………………

……………………… Mobile No. ………...........................................

SIGNATURE