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Acharya Shri Chander College of Medical Sciences & Hospital Complex,

N.H. Bypass, P.O. Majeen (ASCOMS), Sidhra, Jammu – 180017

Tele Nos. 0191-2662268, 2662270,2130067



APPLICATION FORM AND CONDITIONS LAID DOWN FOR THE

NRI/NRI WARDS SEATS

FOR MD/MS COURSES SESSION-2014
1. INTRODUCTION

1.1 Acharya Shri Chander College of Medical Sciences & Hospital, Sidhra, is located at a picturesque, pollution free hill slope above river Tawi at Sidhra, Jammu.


1.2 The distance of the College and Hospital is 8 Km from Jammu Railway Station, 10 Km from general bus stand, Jammu and 15 Km from Jammu Airport.
1.3 The College is affiliated to the University of Jammu, Jammu.
1.4 The College has been accorded Minority status in J&K State by the J&K Government vide Govt. Order No. 940-HME of 1997, dated 27-10-1997.
1.5 For NRI candidates, application form is available on the website: www.ascomscollege.com.
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2. NUMBER OF SEATS

Postgraduate Courses have been recognized by Govt. of India, Ministry of Health & Family Welfare (Department of Health) vide order No.U.12012/15/2003-ME(P) dated 19-09-2003.


2.1 In accordance with regulations of the Medical Council of India, the Jammu & Kashmir Govt. vide order No.202-HME of 2004 dated 07-04-2004 has approved two seats as NRI quota vide Jammu & Kashmir Govt. order No. TRB/Res./15/2010 dated 09-08-2010 and SRO No.246 Two seats are available in the below mentioned disciplines for eligible NRI candidates:-
S.No Name of Discipline Total

1. MS General Surgery 1

2. MS Anaesthesia 1
The selection under NRI category is based on merit obtained in the CET conducted by Association of Private Unaided Medical & Dental Colleges in J&K. NRI applicants will have to appear in this CET and would have to qualify with aggregate 50% marks to be eligible for selection in order of merit which would be determined separately for NRI applicants.

3. APPLICATION FORM AND FEE

3.1 Application form can be downloaded from the website of this Institution www.ascomscollege.com. Application form accompanied with a draft for US $ 100.00 or equivalent to Indian currency, complete in all respect must be submitted by 3.00 p.m. on or before 7th March 2014 in the college office of the Director Principal ASCOMS & Hospital, Sidhra, Jammu. The cost of prospectus includes examination fee also and is non refundable.



    1. The duration of Postgraduate course will be 3 years.

3.3 Fee: Fee for undergoing MD/MS courses has been fixed vide Govt. order No.

511-HME of 2013 dated 11-09-2013 at US $ 14,500/- per student per year on the recommendation of the Committee for Fixation of Fee Structure of Professional Colleges constituted vide Govt. order No. 149-Edu(Tech) of 20912 dated 23-08-2012.
4. ELIGIBILITY

4.1 Any candidate who himself/herself is NRI or whose parents are NRI is eligible to apply for admission to MD/MS Courses under NRI category.

Any candidate who claim to be a ward of the NRI is also eligible to apply provided that he/she falls within the definition of “WARD”.
WARD MEANS” Only that person who has a guardian appointed by the Court to take care for and take responsibility of that person.

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4.2 The applicant must have passed the MBBS degree with aggregate marks not less than 50% from any recognized University or an equivalent degree recognized by the University of Jammu and the Medical Council of India and should be registered with the State Medical Council/Medical Council of India with minimum of 50% marks.


4.3 Candidates who have completed the MBBS course from any Institution outside India are required to have passed the examination conducted by National Board of Examination, New Delhi.
4.4 The applicant must have completed satisfactorily one year’s pre-registration compulsory rotatory internship as laid down by the M.C.I. and the University of Jammu for registration as a Medical Graduate.
5. SUBMISSION OF FORMS

5.1 Application forms Nos. 1 to 4 complete in all respects must reach the office of The Director Principal, Acharya Shri Chander College of Medical Sciences & Hospital, Administration Block, Ground Floor, National Highway Bye pass, P.O. Majeen, Sidhra, Jammu-180017, by 3.00 p.m. on or before 7th March 2014.


5.2 Application forms received after the expiry of prescribed date shall not be entertained.
5.3 Candidate must enclose one self addressed Envelopes (4”x9”) affixed with postal stamps for Rs 35/- along with application form.
5.4 4 copies of recent high contrast passport size photograph with light background are required to be pasted in Forms Nos. 1 to 4. Polaroid Photographs shall not be accepted.
5.5 The photograph must be snapped with a placard indicating name and date of taking the photograph of the candidate. The photographs must be snapped on or after 01-02-2014. The name and date on the photographs must be clear and legible. Photograph should be without cap or goggles, however, spectacles are allowed.
5.6 The photographs must be attested by a gazetted officer in such a way that part of signature is on the application form as well as on photograph. Attestation should be done on the bottom part of the photograph so that photograph is not defaced with a clear stamp/office seal on bottom side.
5.7 The photographs should not be defaced. It should be firmly affixed on the application form Nos. 1 to 4 with adhesive (gum/Fevistick) and should not be pinned up or stapled.
5.8 One copy of the unattested photograph of the candidate duly signed by the candidate on its backside must be enclosed separately in small polythene envelope for use in the OMR sheet at the time of test in the examination hall.
5.9 While filing column 7 of the application form and computer sheet, candidate must indicate his/her options preference wise as per the codes in the respective squares.

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5.10 The candidate must fill all the forms and forward all these to the Director Principal, Acharya Shri Chander College of Medical Sciences & Hospital, National Highway Bye Pass, P.O. Majeen, Sidhra, Jammu-180017.
6. CERTIFICATES TO BE ATTACHED

Attested photocopies of the following certificates be attached with the application forms:



    1. MBBS degree certificate obtained by the applicant from a University, recognized by the University of Jammu and the Medical Council of India.




    1. Registration Certificate of State Medical Council or the Medical Council of India.




    1. The student who has qualified MBBS from other countries must give details of the Institution, marks obtained, total marks and grade obtained. Student must have passed the test conducted by National Board of Examination, New Delhi, India for recognition of his/her degree by MCI (Candidates must attach the certificate of marks obtained in the National Board of Examination, New Delhi).




    1. Marks sheets of 1st professional, 2nd professional, Pre-Final and Final MBBS examinations.




    1. Compulsory Rotatory Internship Certificate issued by the recognized University.




    1. Date of birth certificate (Matriculation, Secondary School examination certificate from Board/University (attested copy only).




    1. Document of proof of NRI (Citizenship/P.R Card etc.), i.e. establishment of relationship. Passport of NRI (Scan copy).




    1. The applicant shall have to produce the original certificates before the admission committee of college at the time of admission. If during scrutiny or anytime thereafter any discrepancy or incorrectness is noticed, the admission is liable to be cancelled forthwith. The candidate could be expelled and criminal action shall be initiated against him.

7. COMPLETING OF APPLICATION FORM

7.1 Before filling the particulars in the applications form, candidate must study the condition laid down therein and also go through the relevant notification carefully and thoroughly.
7.2 All particulars be written by the candidates in his/her own handwriting.
7.3 Candidates are advised to give their Mobile & landline Telephone numbers, Email and Fax number if any, for speedy communication.
7.4 For making all entries use double-digit numbers from one to nine such as 01,02,03,04,05,06,07,08,09.

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7.5 The candidate must fill all the forms i.e. Application form, Computer Sheet, Attendance Sheet, Admit Card and Acknowledgement and forward to the Director Principal, ASCOMS & Hospital, Sidhra, Jammu-180017.


7.6 The form will also be rejected if any candidate supplies incorrect information and no refund of fee on this account shall be made.


  1. MODE OF SELECTION

    1. The test shall be conducted at specified centers at Jammu City only.




    1. Admit Card will be issued to eligible candidates through speed post/registered cover only on 11-03-2014 from the office of Director Principal, Administration Block, ASCOMS & Hospital, Sidhra, Jammu-180017.

8.3 Candidates will appear in the Common Entrance test at Jammu at their own cost. No candidate will be allowed to appear in the Common Entrance Test without the Admit Card issued by the Director Principal, ASCOMS & Hospital, Sidhra, Jammu-180017.


8.4 Candidates selected for admission in the College will be required to produce a Medical Fitness Certificate issued by a qualified Doctor (Medical Graduate/Post Graduate).
8.5 The waiting list of candidates discipline wise shall also be prepared in order of merit secured by the candidates in Common Entrance Test.
8.6 All disputes in relation to the selection or otherwise shall be subject to the territorial jurisdiction of court at Jammu.
9. CENTRES OF EXAMINATION

9.1 Candidates shall be informed in writing on the admit cards about the Institutions in which their centers have been fixed.


9.2 Centre of examination once allotted will not be changed.
9.3 Candidates shall also have to preserve the admit card till the allotment of seat and completion of selection process.
9.4 Duplicate admit card will be issued only on production of solid evidence for loss of original one and valid identity proof.
10. CONDUCT OF EXAMINATION

10.1 Examination centre will be opened 30 minutes before the commencement of the examination.


10.2 Candidates who do not possess the Admit Card will not be allowed to sit in the examination hall. The card must be shown on demand.
10.3 Candidates are advised either not to carry any material in the examination hall.
10.3 Smoking in the examination hall shall not be allowed.

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10.4 The seating plan shall be displayed outside the examination hall.
10.5 No candidate will leave the examination hall before expiry of full time and without handing over the original OMR answer sheet to the invigilator on duty.
10.6 The Common Entrance Test will be conducted as per the Syllabus for MBBS Course prescribed by the University in the following subjects:-

Section ‘A’

Subject No. of Questions

Anatomy 10

Physiology 10

Biochemistry 10

Pharmacology 10

Pathology 20

Microbiology 10

Forensic Medicine 10

Community Medicine 20

___


Total 100

Section ‘B’

Subject No. of Questions

Medicine 25

Surgery 20

Paediatrics 05

Obstetrics & Gynaecology 05

Ophthalmology 05

Orthopaedics 05

E.N.T. 05

Anaesthesia 10

Dermatology 05

Psychiatry 05

Radio-diagnosis 10

___

Total 100



    1. The Common Entrance Test shall be of three hours duration.




    1. The Question Paper Booklet shall have two sections viz. ‘A’ and ‘B’ as indicated above.




    1. The total number of marks will be 200 i.e. one mark for one question.




    1. The candidate will fill in the required particulars in the question booklet and the OMR answer sheet before attempting the questions.




    1. The candidates do not have to write answer or mark them in the question booklet. They will select the correct/most appropriate answer for each question and darken the option number in the circle provided against the specific question number in the answer sheet with a black ball point pen to be provided by the Association in the Examination Hall.

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    1. For each correct answer the candidate will get one mark. There shall be no negative marking.




    1. Any rough work to be done by the candidates, only on the rough sheets attached with the question booklet.



NOTE: The candidate who is NRI/NRI WARDS shall have to produce necessary proof of relationship if applicable in support thereof to the satisfaction of the concerned Admission Committee of College.

10. BANK GUARANTEE



Candidates selected to undergo Postgraduate Programme shall furnish a Bank Guarantee for US $ 29,000/- for subsequent 2 years of the 3 years Postgraduate degree course under taken by the candidate to the satisfaction of the Institution, along with first year admission fee, for sum of US $ 14,500/-to be paid to the Director Principal Acharya Shri Chander College of Medical Sciences, Sidhra, Jammu being Annual Fee. The college will realize the bank guarantee in case the candidate leaves the course midstream i.e. before completion of three years.

Acharya Shri Chander

College of Medical Sciences and Hospital Complex,

N.H. Way, Bye Pass, P.O. Majeen (ASCOMS) Sidhra, Jammu-180017

(Application for admission against Foreign Students/NRI/Wards of NRI seats in the College)




  1. Name of the student ____________________________________

2. Father’s Name ________________________________________


3. Are you a foreigner? (Write Y for Yes and N for No) ___________
4. Are you a NRI or ward of NRI? (Give details particulars of the NRI person along with

A certificate confirming that you are his/her ward).


5. Name of the NRI ________________________________________
6. Relationship ___________________________________________
7. NRI’s full postal address:

(i) Permanent _______________________________________

________________________________________________
(ii) Correspondence _____________________________________

___________________________________________________

Telephone No. if any ____________________________

Mobile No. ___________________________________

Email address ________________________________

Fax No. _____________________________________

8. Sex (Write M for Male and F for Female ______

9. Religion ____________________

10. Nationality ____________________________

11. Candidate’s full postal address:

(i) Permanent _______________________________________

________________________________________________


(ii) Correspondence _____________________________________

___________________________________________________

Telephone No. if any ____________________________

Mobile No. ___________________________________

Email address ________________________________

Fax No. _____________________________________


12. Place of Birth

(a) Country ________________________

(b) State __________________________

(c ) District _________________________

(d) Tehsil _________________________________

(e) Village/Town __________________________

13. In case the place of birth is outside India, give the following details:-

Present Nationality ______________________

Country of your present passport _______________________

Passport valid up to _________________________________

Passport Number ___________________________________

Issuing authority ____________________________________

14. Category:

Please tick accordingly (√) NRI NRI’s WARD

15. Documents submitted for proof of origin

____________________________________________________

____________________________________________________

FORMAT OF UNDERTAKING LETTER FOR NRI/NRI’s WARD POSTGRADUATE MD/MS COURSES

(Attested by legal authority)

To
The Director Principal

ASCOMS and Hospital

Sidhra, Jammu


Subject: Undertaking by the NRI/NRI’s Ward

Sir,
I, ______________________________ NRI/NRI’s Ward residing at _____________

_______________________________________ (Abroad) hereby undertake the responsibility of Mr. Ms. ____________________________________ (Candidate).

Residing at _______________________________________________________________

________________________________ (hereby in after called the “student”) for admission to the Postgraduate MD/MS Courses in ASCOMS, Sidhra, Jammu (herein after called the “student”) under NRI seat quota.
I hereby agree, affirm and declare that if the student is granted admission, I agree and undertake to pay the fees as would be determined by the competent authority in NRI on the date of admission and further undertake due compliance with fee structure and other associated rules and regulations of the College. I also agree to undertake to pay the prescribed fees for each term if the study is prolonged beyond the normal prescribed duration.

I will also be fully responsible for the total financial support including all expenses on academic, living and traveling of the student and I will bear at the same.


Date:

Yours faithfully

Place:

_____________________



(Signature of NRI/NRI’s ward)

The above declaration is duly attested by legal authority _________________


Name and Signature of legal authority

NOTE: This under taking must typed on the letter head giving details of address and must accompanied by the following information of the NRI/NRI’s ward.

      • Complete introduction of the Parent/Guardian

      • Indian passport number

      • Residence Certificate/permanent residence card

      • Confirming relationship with the ward

Form No. 1 Sr. No._______


Acharya Shri Chander

College of Medical Sciences and Hospital Complex,

N.H. Way, Bye Pass, P.O. Majeen (ASCOMS) Sidhra, Jammu-180017
APPLICATION FORM FOR NRI CANDIDATES



Space for high contrast passport size photograph duly attested by a Gazetted officer to be pasted depicting name and date of taking the photograph

Application form of Common Entrance Test for admission to NRI/Children of

NRI’S/Wards of NRI’S seats in the Postgraduate MD/MS Courses in

Acharya Shri Chander College of Medical Sciences & Hospital.


Note: Form should be filled in by the candidate with his/her own handwriting

with black ball point pen.


Roll No. _________________

(To be allotted by the examining body) Note: Photograph should be



attested by a Gazetted

officer and pasted firmly.

1. Name in block letters





























































(First Name) (Middle Name)



































(Surname)

2. Date of Birth

































D D M M Y Y Y Y
3. Identification mark of the candidate __________________________________________________

4. Father’s Name in block letters (leave space to indicate different parts of the name)









































































5. Father’s/Guardian’s Profession: _________________________________________
6. Sex (M for male and F for Female)




7. Subject Options

(Write down subject codes in the given squares)

1st 2nd

















Subject wise codes: (General Surgery-03, Anaesthesia-05)
8. Correspondence Address: ___________________________________________________

___________________________________________________ ___________________________________________________

Mobile/Telephone No. (if any) _____________ Fax No. (if any) _________________________

E mail (if any) ___________________________



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09. (a) Performance at the Qualifying Examination:



Class

Name of Institution

Name of University


Year of passing

Max Marks

Marks

Obtained

% age

Grade

1st Prof.






















2nd Prof.






















Pre-Final Prof.






















Final Prof.












































    1. Incase students

who have done

MBBS course from Institutions outside India, their performance at National Board of Examination, New Delhi.
9.(b) I am seeking admission to P.G. Course in the following subjects under NRI quota












General Surgery Anaesthesia

Please tick the choice (√)





    1. Internship Details


Date

Name of the College/Hospital

From

To









































Signature of the Candidate
Thumb’s Impressions of the candidate to be put in the space provided below in the presence of attesting

authority at the time of filling the form.

Right thumb

Left thumb










(Seal/signature of the attesting authority*)

*If the Seal/Stamp is not clear, the form will be rejected with out assigning any reason

For office use only

Signature of the scrutiny committee:
1. ___________________________ 2. ___________________________
3. __________________________ 4. ___________________________
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DECLARATION

I hereby solemnly affirm that the statement made by me in this application form is true, complete and correct. should it be found on verification or otherwise, before or after the conduct of Common Entrance Test that I have given herein false, incorrect, untrue information in material/particulars. I shall have no objection if my application/candidature is rejected or my consequent selection/admission is cancelled without refund of any fee paid. I also understand that in such an event, the college will be at liberty to take any other action against me as deemed necessary.

I agree to abide by the conditions governing the Entrance Test as contained in the relevant Information Brochure.

Dated: ________________________ Signature of the candidate

I have fully read the information furnished by my son/daughter/ward and affirm that the same is true and if it is found that the information is untrue/incorrect, I am liable to criminal prosecution.

Date: ___________________ Signature of Father/Guardian
Profession _______________
I hereby certify that the information furnished by the aforesaid candidate is correct as per my personal knowledge.

Dated: ____________________ Signature of the Gazetted officer

(with designation and clear office seal/stamp)
List of enclosures attached with the application form (Attested photo copies only)
1. ____________________________________________________________________
2. ____________________________________________________________________
3. ____________________________________________________________________
4. ____________________________________________________________________
5. ____________________________________________________________________
________________________________________________________________________
FOR OFFICE USE ONLY

The candidate is eligible/not eligible to sit in the common entrance examination.


Dated : ________________________ Signature of Officer incharge

Form No. 2 Sr. No._______


Acharya Shri Chander

College of Medical Sciences and Hospital Complex,

N.H. Way, Bye Pass, P.O. Majeen (ASCOMS) Sidhra, Jammu-180017
COMPUTER SHEET FOR NRI CANDIDATES



Space for high contrast passport size photograph duly attested by a Gazetted officer to be pasted depicting name and date of taking the photograph

Application form of Common Entrance Test for admission to NRI/Children of

NRI’S/Wards of NRI’S seats in the Postgraduate MD/MS Courses in

Acharya Shri Chander College of Medical Sciences & Hospital.


Note: Form should be filled in by the candidate with his/her own handwriting

with black ball point pen.


Roll No. _________________

(To be allotted by the examining body) Note: Photograph should be



attested by a Gazetted

officer and pasted firmly.

1. Name in block letters (leave space to indicate parts of the name)
































































































2. Date of Birth


D D M M Y Y Y Y


3. Identification mark of the candidate: _________________________________________________
4. Father’s Name in block letters (leave space to indicate different parts of the name)







































































5. Father’s/Guardian’s Profession: _________________________________________



6. Sex (M for male and F for female)

7. Subject Options

(Write down subject codes in the given squares)

1st 2nd


















Subject wise codes: (General Surgery-03, Anaesthesia-05)
8. Correspondence Address: ___________________________________________________

___________________________________________________ ___________________________________________________

Mobile/Telephone No. (if any) _____________ Fax No. (if any) _________________________

E mail (if any) ___________________________


Signature of the candidate

Form No. 3 Sr. No._______


Acharya Shri Chander

College of Medical Sciences and Hospital Complex,

N.H. Way, Bye Pass, P.O. Majeen (ASCOMS) Sidhra, Jammu-180017
ADMIT CARD FOR NRI CANDIDATES



Space for high contrast passport size photograph duly attested by a Gazetted officer to be pasted depicting name and date of taking the photograph

Application form of Common Entrance Test for admission to NRI/Children of

NRI’S/Wards of NRI’S seats in the Postgraduate MD/MS Courses in

Acharya Shri Chander College of Medical Sciences & Hospital.


Note: Form should be filled in by the candidate with his/her own handwriting

with black ball point pen.


Roll No. _________________

(To be allotted by the examining body) Note: Photograph should be



attested by a Gazetted

officer and pasted firmly.
1. Name ___________________________________________________________________________
2. Father’s Name ____________________________________________________________________
3. Identification Mark of the Candidate ___________________________________________________
4. Signatures of the Candidate_________________________________________________________
I certify that the candidate has put his/her signatures on this Card in my presence and that he/she is the actual Candidate whose photograph is above on the Card which is duly attested by me.


Signature & seal of the Gazetted officer


FOR OFFICE USE ONLY
The Candidate with the above particulars is eligible to sit in the Common Entrance Test for admission to Postgraduate Course and be admitted to the same at Centre No. ____________ in ______________________________________________________________________________________
________________________________________________________
(Name of the Institution)

The Common Entrance Test is scheduled to be held on _________________________________ at


________________________________


Signature of Officer I/C (Exam)

Form No. 4 Sr. No._______


Acharya Shri Chander

College of Medical Sciences and Hospital Complex,

N.H. Way, Bye Pass, P.O. Majeen (ASCOMS) Sidhra, Jammu-180017
ATTENDANCE SHEET FOR NRI CANDIDATES


Space for high contrast passport size photograph duly attested by a Gazetted officer to be pasted depicting name and date of taking the photograph

Application form of Common Entrance Test for admission to NRI/Children of

NRI’S/Wards of NRI’S seats in the Postgraduate MD/MS Courses in

Acharya Shri Chander College of Medical Sciences & Hospital.


Note: Form should be filled in by the candidate with his/her own handwriting

with black ball point pen.


Roll No. _________________

(To be allotted by the examining body) Note: Photograph should be



attested by a Gazetted

officer and pasted firmly.
1. Name ___________________________________________________________________________
2. Father’s Name ____________________________________________________________________
3. Identification Mark of the Candidate ___________________________________________________


  1. Signatures of the Candidate_________________________________________________________


Note: This attendance sheet shall be presented to the candidate in the Examination Hall at the beginning of the Test for filling in columns No. I to VI. In case the Candidate is absent, the officer incharge of the examination shall write “Absent” in the columns VI.


Date

I

Name of the CET

II

Booklet

Number

III

Booklet

Series

IV

OMR Answer sheet number

V

Signature of the Candidate

VI

















While filling up the application form, please do not put Thumb Impressions in the space provided below:

Left thumb Right thumb









Thumb Impressions of the candidate to be put in the presence of the Superintendent in the Examination centre only.
Certified that the entries in this Attendance Sheet and thumb impressions have been made by the candidate in my presence in the Examination Centre.

Signature of the Invigilator Signature of the Superintendent
Acharya Shri Chander

College of Medical Sciences and Hospital Complex,

N.H. Way, Bye Pass, P.O. Majeen (ASCOMS) Sidhra, Jammu-180017

ACKNOWLEDGEMENT CARD FOR NRI CANDIDATES
Sr. No.___________
Received an application from: _____________________________________________
S/o, D/o ______________________________________________________________
for Common Entrance Test for admission to Post graduate Courses for the session ______

Receipt Clerk


Rs 5/- Postal Stamp to be fixed by the Applicant
To
__________________________________________________
__________________________________________________



_________________ Pin Code
From:
Acharya Shri Chander

College of Medical Sciences and Hospital Complex,

N.H. Way, Bye Pass, P.O. Majeen (ASCOMS) Sidhra, Jammu-180017

Annexure-I
UNDER TAKING REGARDING AUTHORIZATION FOR COUNSELING
I, _______________________________ son/daughter/wife of Mr. _________________________ aged _______ years_____ months, bearing Roll No. ____­­________ placed at Rank No. _____________ in the Common Entrance Examination for admission to MD/MS Courses Session-2014, conducted by Association of Private Unaided Medical & Dental College C/O ASCOMS, Jammu do hereby solemnly affirm and undertake that the decision of my authorized representative, Mr./Mrs./Miss_________________________________ __________________________son/daughter/wife of Mr. _________________________________________ aged _____ years, regarding selection/rejection of seat on the date of personal appearance ________________ shall be binding upon me and I shall not have any claim whatsoever, other than the decision taken by my authorized representative on my behalf on _________________.

Signature of Candidate _______________________

Name ______________________________________

Roll No. ____________________________________

Rank ______________________________________

Address ___________________________________


AUTHORITY LETTER

I, ______________________________ son/daughter/wife of Mr. ____________________________ bearing Roll No. ____________ for Common Entrance Examination for admission to MD/MS Courses Session-2014 do hereby authorize Mr./Mrs./Miss ____________________________________________ son/daughter/wife of Mr._______________________________________________________________ R/O ____________________________ to represent me on ___________ (Date) before the committee for allotment of a seat in MD/MS Courses, Session 2014. The signatures and the photograph of above named Mr./Mrs./Miss _____________________ _____________________are attested below.




Photograph of candidate attested by Gazetted officer

Signature of the Candidate ________________________

Name ______________________________________

Roll No. ____________________________________

Rank ______________________________________

Address ____________________________________

_____________________________________

_____________________________________




Photograph of authorized representative attested by the candidate

Signature of authorized ____________________

representative duly

attested by the candidate

Note:- Signature & Seal of attesting authority should cross over the photographs.

Annexure-II
UNDER TAKING/AUTHORIZATION FOR COLLECTING THE ADMIT CARD

I, __________________________son/daughter/wife of Mr. ________________________ R/O ___________________________________________aged ____ years____ months, filled the Common Entrance Test form on ________________ for MD/MS Courses Session-2014, to be conducted by Association of Private Unaided Medical & Dental College C/O ASCOMS, Jammu do hereby solemnly affirm & undertake that I authorize Mr./Ms. _________________________________________________________ son/daughter/wife of Mr. ________________________________________________________________ R/O _________________________ aged ____________ years _________ months, to collect the Admit Card on my behalf from the office of Director Principal, Administration Block, Ground floor, ASCOMS & Hospital, National Highway Bye Pass, P.O. Majeen, Sidhra, Jammu-180017.




Photograph of candidate attested by Gazetted officer

Signature of Candidate _______________________

Name ______________________________________

Roll No. ____________________________________


Address ____________________________________

____________________________________

____________________________________

Photograph of authorized representative attested by the candidate

Signature of authorized _____________________

Representative duly

Attested by the candidate



Note: - Signature & Seal of attesting authority should cross over the photographs.

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