brochure for 2017-18 mbbs admission - kar admission brochure...1 requisition letter addressed to the...
TRANSCRIPT
Government of Karnataka
Karwar Institute of Medical Sciences, Karwar (An Autonomous Institution)
M G Road, Karwar, Uttara kannada District
Website: www.kimskarwar.kar.nic.in Email id: [email protected] Phone No. 08382 -226650 Fax No. 08382-220364
BROCHURE FOR 2017-18 MBBS ADMISSION
Information Regarding Admission Dr. Prakash H. M Mobile No: 9751439069
Hostel Warden: Girls – Dr. Rashmi – 9448555330
Boys – Dr. Muniyappanavar N S - 9886624398
Office:-08382- 223903
www.kimskarwar.kar.nic.in
College fee to be paid by DD / Net banking
State Bank of India, Main branch, Green street, Karwar
Account name: Director & Dean, Karwar Institute of Medical Sciences, Karwar
Account number: 35886153551
IFSC code: SBIN0000857
IMPORTANT
1. No forms/proforma will be issued at KaIMS office as they are made available in KaIMS website. 2. MANAGEMENT SEATS ARE NOT AVALIABLE AS THIS IS A GOVERNMENT COLLEGE.
3. The mobile number of the candidate that is furnished to the Principal office will be submitted to the
University. During examination time, the OTP from University will be sent to the same number for filing
the examination forms. Therefore, students are hereby instructed to retain the same mobile number
through-out the course. 4. Please call only during office hours. Direction map of the College is enclosed.
5. An induction programme for all the I MBBS students will be held in the first week of August 2017.
Kindly contact Dr. Prashant Naik (Ph.8494836655) and Dr. Abhishek (Ph.9964057632) 6. Bonds are available at Cooperative Banks, Karwar or elsewhere.
DOCUMENTS TO BE PRODUCED AT ADMISSION
Sl
No PARTICULARS
1 Requisition letter addressed to the Principal, KaIMS Karwar requesting for MBBS admission (proforma enclosed)
2 Form-I and Form-II (proforma enclosed )
3 NEET allotment order
4 NEET marks card
5 Admit card/ counseling letter results sheet (for All India Quota Students)
6 Original challan for having paid college fee
7 10th
marks card / 10th
passing certificate
8 12th
marks card / 12th
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 (for 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 board other than Karnataka PU board
19 Physical fitness certificate (Medical certificate) from KaIMS teaching Hospital /District surgeon
20 Regional Language & English translated caste certificates from eligible NEET students to be submitted during admission by SC/ST/CAT-1, 2a, 2b, 3a & 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 the eligible NEET students to be submitted during admission by SC/ST/CAT-1, 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 student to be typed in Rs.200/- E-stamp paper and duly attested by notary (proforma enclosed).
23 Annexure I. Part-II:- Undertaking by parent /guardian-to be typed in Rs.200/- E-stamp paper and
duly attested by notary (proforma enclosed)
24 Undertaking -MBBS degree programme as per RGUHS curriculum- to be typed in Rs.50/- E-stamp paper and duly attested by a notary (proforma enclosed)
25 Rural service bond by candidates who select MBBS seats in KaIMS, Karwar-to be typed in Rs.200/-
E-stamp paper and attested by a notary (proforma enclosed)
26 Six (06) 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 2 plastic folders /file with latest photographs affixed on it including name and address of the candidate. Please provide good quality thick folder of safe keeping of your ORIGINAL certificates
voluntarily deposited with college.
28 5 self addressed Rs.30/- Stamped Envelopes.
NO. KAIMS/
/2017-18
Office of the Director
Karwar institute of Medical sciences Karwar
OFFICE MEMORANDUM
Sub: MBBS Phase-I admission through KEA Bangalore-2017 and voluntary deposition of original certificates /testimonials - reg
Ref: KEA Bangalore online generated admissions order No: ________
dt
_______ 2017
Mr./Miss_________________________with NEET No._________, Rank No: ___________with allotted
Category _______________who has been allotted to Karwar Institute of Medical Sciences, Karwar
during __________ counseling round, has reported and provisionally admitted to MBBS Phase-I on
___________2017 subject to the approval of concerned authorities. He/she has submitted all relevant
original certificates and testimonials to this college on his/her own will on the condition that admission is
subject to approval rules of MCI, RGUHS , Government of Karnataka, Ministry of health and family
welfare, Government of India. The said student and parents have been informed that seat surrender if any
will be directly to KEA, Bangalore.
Principal
Karwar Institute of Medical Sciences
Karwar
To: The Candidate.
Candidate Parent
Signature: Signature:
Name: Name:
Phone no: Phone no:
Email Id: Email Id:
Address : Address :
NO.KAIMS/ /2017-18 Office of the Director
Karwar Institute of Medical Sciences
M G Road, Karwar
OFFICE MEMORANDUM
Sub: MBBS Phase-I admission through AIQ-2017 and voluntary deposition of original certificate /testimonials - reg.
Ref: DGHS-All India Quota 2017 Medical Counseling Committee, New Delhi Online generated
provisional seat allotment letter dated__________
Mr./Miss_________________________with NEET No._________, Rank No: ___________with allotted
Category _______________who has been allotted to Karwar Institute of Medical Sciences, Karwar
during __________ counseling round, has reported and provisionally admitted to MBBS Phase-I on
___________2017 subject to the approval of concerned authorities. He/she has submitted all relevant
original certificates and testimonials to this college on his/her own will on the condition that admission is
subject to approval rules of MCI, RGUHS , Government of Karnataka, Ministry of health and family
welfare, Government of India. The said student and parents have been informed that seat surrender if any
will be directly to MCC, AIQ seat allotting cell of DGHS.
Principal
Karwar Institute of Medical Sciences
Karwar
To: The Candidate.
Candidate Parent
Signature: Signature:
Name: Name:
Phone no: Phone no:
Email Id: Email Id:
Address : Address :
Affix
recent photograph
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. PARTICULARS INFORMATION TO BE FILLED
NO
1 Name of the Candidates as per 10th
Marks card.
2 Blood Group
3 Father Name :
Parents permanent Address:
Phone No (of Student & parent/guardian) Email Id (of Student & parent/guardian)
4 Sex
5 Caste Religion :
Caste :
Category :
6 Nationality
7 NEET NO: State RANK:
Allotment/Rank Details AIQ RANK:
8 Marks Scored in NEET Exam Max Marks Marks % of
(Enclosed Details ) Passed Obtained Marks
NEET
Qualifying Exam
Register No in PCU/12th
Class
PUC/12
th 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 Max Marks Marks % of Marks
PUC / 12th
Standard Obtained
Physics
Chemistry
Biology
Total marks
Marks scored in English subject in
PUC / 12th
Standard
Max Marks Marks % of Marks
Obtained
Total marks scored in all subject 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 : Signature of the Candidate :
Date : 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. State AIQ
2 Date of admission
3 Name of the candidate
4 Father name (specify name of the guardian, if father is
not alive)
5 Occupation
6 Permanent address of Parent
7 Correspondence address of Parent
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 :
1. I here with give an undertaking that I will adhere to the rules of good conduct. And will be in general obedient to the teachers and will not any way disturb the harmony of the college and departments.
2. I will not myself indulge in any union activities or such activities undesirous of a medical student.
3. As the parent, will not allow my child or myself instigate my ward to put a case in courts and will try to amicably settle all such disputes firstly within college authorities.
4. I will agree voluntarily to deposit all my certificate and testimonials as prescribed by RGUHS for
verification and admission approval.
Full address of parent:
Mobile number and Email ID of Parent:
Mobile number and Email ID of Candidate:
Place: Karwar Signature of the candidate Date:
Signature of the parent
ANNEXURE l – PART l
UNDERTAKING BY THE 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 and read it fully and explained to my ward.
3. I hereby under take 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 will resubmit such a undertaking again yearly to the Principal KaIMS and reiterate my commitment
4. 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 without any
warning or notice.
Signed this _________ day of _____________________________ month of ______________year
1. Witness (signature & address) Signature:-
Address:__________________________ _________________________________ _________________________________ Mobile Number:
2. Witness (Signature & Address)
SEAL & SIGNATURE OF THE GOVERNMENT NOTARY
l. Party-Student ll. Party- Director KaIMS Karwar
TO BE TYPED IN RS-200 E-STAMP PAPER
ANNEXURE l, PART ll
UNDERTAKING BY PARENT/GUARDIAN
1. I _______________________________________________________________ F/O /M/o / G/o ______________________________________________________ aged _____________ years, Working as__________________________________(occupations), 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. 4. I agree to submit such as undertaking yearly to the Principal, KaIMS.
Signed this _________ day of _________________________ month of ___________ year
1. Witness (Signature & Address) ( ) Signature & address :
2. Witness (Signature & Address)
SEAL & SIGNATURE OF THE GOVERNMENT NOTARY
l. Party-Parent/Guardian II. Party- Director, KaIMS Karwar
TO BE TYPED IN RS.200/-E-STAMP
PAPER
UNDERTAKING ABOUT MBBS DEGREE PROGRAMME AS PER
RGUHS CURRICULUM
I, ___________________________________________________________ Son / Daughter of
______________________________________ (herein after called the Natural Guardian of the Student )
hereby give an undertaking that on admission to I MBBS at Karwar Institute of Medical Sciences, Karwar
during the year 2017-18 have read the rule No.11 of 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 RGUHS regulations.
That no student shall be permitted to join Phase-II (Para Clinical & Clinical) Group of subjects
until he / she Passes in the Phase-I (Pre-clinical) subjects 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 of enrollment. My parents shall also give undertaking that they will visit college every 6 months to
enquire my progress w.r.t attendance and assessments.
Signature of the student with full Address and phone number.
Witness: 1.
2.
Signature of parent
I Party – Candidate
II Party – Director, KaIMS, Karwar
Rs 50/- E-STAMP
EXECUTION OF RURAL SERVICE BOND BY CANDIDATES WHO SELECT MBBS SEATS IN KAIMS, KARWAR.
l Mr./Ms._______________________________, S/o. / D/o._____________________________ a
Candidate with NEET – 2017 Admission Roll No. ______________________ residing at
____________________________________________________________ have been allotted an MBBS
seat on ____________________ in _________________________________________
_________________________________________________ vide admission order
Dated ___________________ and do hereby undertake on my own volition 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, allotted to me, failing which I render myself liable to pay
a penalty of rupees ten lakhs to Government of Karnataka and the Institute as per rules of the Government
in force.
What is stated above is true and correct as per present rules in forces, as decided by the
Government of Karnataka and I hereby undertake to act accordingly. I also understand that if such rules
are changed or notified by Government I and my ward are duty bound to follow such rules also. I have
read and understood the above statement made by my son/daughter on oath-& I have my un-equivocal
consent to the same. I also understand that I /my ward will not claim any job in this regard.
1. Signature of the Candidate
2. Signature of the Parent (Father/Mother)
Date : ___________
Place : ___________
SEAL & SIGNATURE OF THE GOVERNMENT NOTARY
l. PARTY - Student
II. Party_ Government of Karnataka
TO BE TYPED IN RS.200/- E-STAMP PAPER
REQUISITION LETTER: STATE QUOTA STUDENTS
To,
The Principal,
KaIMS, Karwar.
Sir,
Sub: - Request for admission to I year MBBS course at KAIMS, Karwar allotted through Karnataka Examination Authority– reg.
Ref:- Letter No. ___________ dated: _____________ of Executive Director KEA, Bangalore.
-------------------
As per the letter cited under reference, I, Mr / Ms. ________________________________ S/o, D/o. ____________________________, bearing Admission Order No. _______________________, NEET No. _____________ Rank No._____________ belonging to category ___________ have been allotted MBBS seat at Karwar Institute of Medical Sciences, Karwar under ____________ category.
I am herewith voluntarily enclosing the original fee challan for having paid college fees along
with necessary original documents for due verification by RGUHS. 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 those may arise in future with regard to my admission.
Address provided to KaIMS, Along With Phone Number, E-mail id are permanent as on date, and any
changes will be intimated to KaIMS, Karwar.
Yours faithfully,
(Signature of the candidate)
(Signature of the parent / Guardian)
Date:
Place: Karwar
Permanent address of Parent with phone number and E-mail Id
REQUISITION LETTER : AIQ STUDENTS
To
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- 2017 Dated:_________
-----------
As per the letter cited under reference, I, Ms. / Mr. __________________________________
S/o, D/o._____________________________, bearing Admission Order No. ________________,
NEET No.________________ Rank No.____________ belonging to category ___________ have been
allotted MBBS seat at Karwar Institute of Medical Sciences, Karwar under __________ category.
I am herewith voluntarily enclosing the original fee challan for having paid college fees along with necessary original documents for due verification by RGUHS. 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. KaIMS Karwar will not be held responsible for any consequences / objection those may arise in future with regard to my admission. Address provided, phone number, E-mail id are permanent as on date and changes if any will be intimated to KaIMS, Karwar.
Yours faithfully,
(Signature of the candidate)
(Signature of the parent / Guardian)
Date:
Place: Karwar
Permanent Address of parent with phone number and E-mail Id
INFORMATION TO BE FILLED UP BY KARNATAKA CET / ALL INDIA QUOTA STUDENTS
(STRIKE WHICHEVER IS NOT APPLICABLE)
I Mr. / Ms. ________________________________ have been selected to MBBS Course Through
Karnataka Quota / All India Quota 2017 and allotted to KaIMS, Karwar. I am herewith submitting a requisition
letter seeking for admission. My admission details are as follows:-
CET / AIQ Allotment No. and Date:
a. CET / AIQ Rank No.:
b. Category :
c. Allotted Category : d. 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 NEET allotment order
4 NEET 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
8 12th
marks card / 12th
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
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 from KaIMS teaching
hospital)
20 Regional language and English translated caste certificates to be
submitted by SC/ST/CAT-l, 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 and English translated caste certificates to be
submitted by SC/ST/CAT-l, 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 II:- undertaking by the candidate/ student – to be
typed in Rs.200/- E-stamp paper.
23 Annexure I, part II:- undertaking by the parent/ guardian– to be typed
in Rs.200/- 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.200/- E-stamp paper.
26 Six (06) recent colour digital passport size photographs one single
file with latest photograph affixed on it including name and address of
the candidates.
27 Vehicle Driving related affidavit incase of parents allowing children
to ride vehicle.
28 05 self addressed Rs 30/- stamped Envelopes for Correspondence.
Date:
Place: Karwar Signature of Candidate
Signature of Parents
GENERAL INSTRUCTIONS FOR THE STUDENTS WHO ARE TAKING ADMISSION
FOR I- MBBS COURSE AT KARWAR INSTITUTE OF MEDICAL SCIENCES,
KARWAR
1. Students must report in principal’s office at KAIMS for MBBS admission on or before
date indicated on their selection letter issued by KEA / NEET AIQ at 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. 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.
3. One of the parent / guardian must accompany students at the time of admission or demitting seats as certain documents are to be signed by them.
4. The admission process is likely to take two days. Outstation candidates are requested to not cause hurry in admission or demitting seats.
5. The admission offered to a candidate will be only provisional. DME & RGUHS are final authorities.
6. The students are instructed to keep the 5 set Xerox copies with themselves of their original documents until they are returned from Rajiv Gandhi University of Health Sciences, Bangalore. Once submitted no original will be returned, please co-operate.
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. www.kimskarwar.kar.nic.in
9. Institute working hours: 9.00 am to 1.00 pm and 2.00 pm to 5.30 pm. 10. Each candidate must submit the following original certificates shown below along with
four 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.
11. In case of AIQ/NEET seats-seat surrender procedure be duly followed. Kindly generate the online seat surrender receipt and contact the AIQ officer of KaIMS Dr. Prakash H M on 9751439069, message him. Please try to come to KaIMS on working day and remember Karnataka holiday schedules will be different working days are Monday to Saturday, SUNDAY WILL BE HOLIDAY AND GOVERNMENT OF KARNATAKA HOLIDAYS WILL BE HOLIDAYS. KINDLY CALL ON OFFICE NUMBERS 08382-223903 and speak in Hindi, English or Kannada.
12. Learning Kannada for a medical student may be necessary since MBBS students are interacting with patients.
NOTE
1. Students admitted to this institute are expected to strictly follow the codes of discipline
indicated by college authorities, university, and government.
2. Drinking alcohol, smoking or consuming any intoxicants by students is strictly
prohibited. Misbehavior with girl students / women / patients will be dealt as per law.
3. Ragging in any form is punishable by law. An undertaking to this effect signed by the
candidate and his/her parent /guardian must be submitted at the time of admission
compulsorily.(all five affidavits)
4. Candidates are advised to keep a printed copy of their completed application form along
with forms for their record and future reference. You can photograph your submission
too.
5. As per RGUHS syllabus regulation 75% attendance in both practicals and theory is a
must. Non adherence to such rules in force will invite disciplinary actions. It is also the
duty of parents/guardians to periodically ask for Internal marks and attendance of their
ward and participate in education process.
6. No vehicles are allowed to be kept by students or used in the college permises.All parents
must agree to not allow their ward to not use any vehicles. If any parent wishes to allow
wards to use vehicles, they must submit a undertaking in Rs.100/- bond paper to warden.
7. Dress code – Decent formal dressing with shoes and socks is expected from both boys
and girls during working hours when visiting library similar rules apply. While roaming
in campus also kindly wear decent clothes.
8. Library rules and regulations must be followed.
9. Any Incidents of Ragging please report to Dr. Sadananda (9845082223) / Dr. Venkatesh
(9448020607/8310245494)
CONTACT DETAILS
PHONE : 08382 223903
WEBSITE : www.kimskarwar.kar.nic.in
EMAIL : [email protected] ADDRESS : Karwar Institute of Medical Sciences, Karwar, Dist: Uttara kannada, Karnataka,India.Pin Code:581301
Check up will be done in first floor of KAIMS Teaching Hospital/District Surgeon room
The Karnataka Service Regulations (Act.32) KARNATAKA MEDICAL DEPARTMENT
PHYSICAL FITNESS CERTIFICATE
1) In do hereby certify that I have examined…………………………………………………
…………………………………………………………………………………………….. a
candidate for …………………………………………………………………………….. And
that I cannot discover that He/She has any disease constitution affection or bodily infirmity
except……………………………………………………………………………. I do not
consider this disqualification for employment in the office of …………………….
2) I am also satisfied by personal examination/from certificate produced by that the H/She
was vaccinated/re-vaccinated within one week prior to the date of the certificate.
3) ……………………………..’s age is according to His/her own statement……………….
years and by appearance about ………………………….year.
Other Particular’s
1. Height
2. Weight
3. Chest
4. Vision
Medical Superintendent, KaIMS
District Surgeon
District Hospital,Karwar
GENERAL RULES & REGULATIONS OF KAIMS HOSTELS
1) Ragging in any form is banned inside and outside the campus. is punishable.
2) Students should strictly follow the timings of the hostel.
3) Extended hours for studying in the library will be granted on prior written permission.
4) Visitors including parents/guardians are allowed to meet the students in the visitors
lounge during visiting hours and not in their rooms. Overnight stay in the hostel is not
allowed. Entertaining unauthorized guests will lead to severe punishment including
expulsion from the hostel.
5) Students are not allowed to stay in rooms other than the ones allotted to them.
6) Students are responsible for the safety of their belongings. Kindly report any themselves
to warden office in working.
7) Use of tobacco in any form is strictly prohibited.
8) Consumption of alcohol is strictly prohibited.
9) Possession of weapons or dangerous chemicals of any kind is strictly prohibited.
10) Students will not get involved in political activities of any sort or participate in any
anti-national and anti-social or undesirable activity inside or outside the campus.
11) Students are not permitted to stay in rooms during the college hours, unless they are
ill. Any illness and medication student uses should be reported to the Warden.and
principal.
12) Students are not permitted to stay away from the hostel or leave station without the prior
permission from the warden/Principal.
13) Student once admitted to the hostel, cannot vacate it without a written request from their
parents which must be authorized by the Warden/ Principal.
14) Meetings/gathering within the hostel are not permitted. Functions of any kind should
have the prior permission of the Warden.
15) Students are allowed to use table lamps, hair dryers, iron box and chargers. The use of
other electrical appliances is not allowed.
16) Students have to keep their room clean and neat, including bathroom and toilet.
17) Students are not allowed to have meals in their rooms except under special conditions
like illness etc. The permission of the warden is required in such cases.
18) Cooking is not permitted in the hostel rooms.
19) Students are not allowed to use terrace for any purpose without the prior permission of
the Warden.
20) Students are not allowed to use motor vehicles like bikes or cars. Those who are
authorized to use vehicles are required to park in an orderly manner in the space
provided. The students using vehicles should possess the valid driving license/ vehicle
registration documents.
21) Any damage to the hostel property will attract a fine. The students residing in the room is
responsible for any damage to the property within the room and will bear the cost of
damage. In case of damage or loss of hostel property the cost will be recovered from the
students of the hostel as decided by the Warden.
22) All students are required to maintain high standards of discipline in the college campus
and hostel premises. In case of breach of discipline and failure to abide by the rules and
regulations, the hostel committee will render the students liable to disciplinary action.
23) Any indisciplinary or undesirable activities occurring in the hostel should be brought to
the notice of the Warden/Principal.
24) Warden/Principal / Director are the final authority to take up decisions in any untoward
incidents.
SD/-
Wardens of Boys Hostel
SD/-
Wardens of Girls Hostel
SD/-
Principal
Karwar Institute of Medical Sciences
Karwar
GIRLS HOSTEL RULES
1. Follow the hostel timings strictly
a. Timing to go out in the morning after 7.00 am
b. Timing to come back in the evening before 8.00 pm
2. Fine for Keeping tap open – 1000/-Rs per person. 3. Fine for keeping fan, bulbs and electrical items on Rs – 500 per head 4. Mess bill has to be Paid before 10
th of every month, if delayed 50/-Rs fine
a. Per day will be collected. 5. If the students want to go out of campus they have to take written
permission of warden. 6. Mess timings:
a. Tiffin :7.30am-9.00am
b. Lunch :12.30pm-3.00pm
c. Dinner :7.30pm-9.00pm
7. Mess bill – deduction will be considered if remain absent for continuous five
days. 8. No male relative is allowed to enter the room without permission.
9. Single lady companion is allowed to stay with the student with warden permission.
10. NO SINGLE ROOMS ARE AVAILABLE FOR WHAT SO EVER REASON AND
SUCH REQUESTS WILL NOT BE ENTERTAINED ALL room will be 3 seats rooms.
*** If students violate hostel rules and if any untoward incident happens, students are responsible themselves & strict action will be taken.
SD/-
Chief Warden
Girls Hostel KAIMS Karwar
UNDERTAKING BY THE PARENT
Rs 100/- bond paper to Hostel Warden. Vehicle DL Xerox copy to be submitted with this bond. Of the student who wishes to keep vehicle in the campus.
I. ____________________ father of / guardian of _________________ / mother of ______________ student of I / II /III MBBS herewith give a undertaking to this effect that my child / ward ______________ has kept a vehicle __________ Model ________ Make _________ ____________ Vehicle No.___________ at KAIMS campus. He/she in legally eligible to drive vehicle and His/her vehicle DL is valid DL No is _______________ Any Mishaps/ accidents, any injuries to self others an account of driving by my ward is solely the responsibility of my child and myself. I will not allow such vehicle to be driver rashly or cause physical injury to other citizens. While driving such a vehicle my child will ensure dignity of my family, college and such vehicle permission will not be misused by letting or renting vehicle or flouting the MV act. Also such vehicle driver shall display on vehicles the sign “L” for learner and perse Helmets for himself/herself and the pillion rider.
Signature of child wishing to
Use vehicle Signature of parent Mobile number Address
Witness (address with mobile no)
1.
2.
ENVIRONMENTAL PLEDGE
(Each student must give this pledge)
I__________________________________S/O_____________________________
Hereby Pledge that I voluntarily agree to plant and maintain tree in my college campus, and I
will also take care of the plants/trees entrusted to me by the college authorities. I shall participate
in all such environment friendly activities assigned to me with full dedication.
Signature of Candidate Signature of Parents
COLLEGE FEES STRUCTURE
1st Year Sl
Particulars
No
GM/OBC
SC/ST
AIQ
1 Registration Fee
3500
3000
3500
(University)
2 Admission Fee
1400
900
1400
(University)
3 N.S.S (University) 50 50 50
4 Sports Fee (University) 4
900
900
900
1/2 years
5 Student Welfare fund (to
450
450
450
the University) 4 1/2 year
6 Helinet Fee (University) 4
4500
4500
4500
1/2 year
7 Tuition Fee 9200 - 9200
8 Library Fee 1500 1500 1500
9 Sports Fee (college) 600 600 600
10 Laboratory Fee 500 500 500
11 Medical examination Fee 150 150 150
12 Caution Money Deposited
1000
1000
1000
(Refundable)
13 Alumni Association Fee
750
750
750
(life time)
14 Examination Fee 300 300 300
15 Marks card Fee - - -
16 Application Fee
100
100
100
(Admission)
17 Fine - - -
18 Eligibility Fee - - -
19 Association Fee 500 500 500
20 Magazine Fee 500 500 500
21 Kannada Sangha 200 200 200
22 Identity Card 100 100 100
23 Student Welfare fund (for
350
350
350
College)
24 Research Fees 100 100 100
25 Digital Library (College) 3600 3600 3600
26 Cultural activities
1500
1500
1500
(College)
27 Literary activities
500
500
500
(College)
GRAND TOTAL 32250 22050 32250
