Undergraduate Course (for the Academic Year ):

Transcription

1 ADMISSION POLICY Undergraduate Course (for the Academic Year ): 1. 15% All India Quota % State Quota % ESIC Management All India Quota % ESIC Management State Quota. Check List for UG Admission I. Admit Cards of Exam issued by Central Board of Secondary Education (CBSE). II. Rank Letter issued by CBSE. III. Date of Birth Certificate (if Matriculation Certificate does not bear the same). IV. Matriculation Certificate. V Certificate (in original to be submitted to the Reporting Institute). VI Mark-Sheet (in original to be submitted to the Reporting Institute). VII. Relieving Letter from previous Institution (if applicable). VIII. 6 Passport size photographs, same as affixed on the application form. IX. Provisional allotment letter generated on- line. X. Domicile Certificate (for state candidates only). XI. Verification Form from R.G. Kar Medical College (not for AIQ). XII. Medical Certificate from Registered Medical Officer. XIII. E- Challan Transaction Id Reporting Center copy (not for AIQ). XIV. Four (4) Demand Drafts each drawn in favour of ESI FUND ACCOUNT NO-1, Payable at Kolkata: Rs. 24,000/- (Annual Tuition Fee) Rs. 5,000/- (Annual Caution Money-Refundable) Rs. 4,200/- (Annual Hostel Seat Rent- Optional) Rs.10,000 /- (Hostel and Mess security-optional & refundable) XV. Notorised Bond of Rs.1,00,000/- (Rupees One Lakh) on a Non-Judicial Bond paper of Rs.10/- (Rupees Ten). {Format enclosed in Annexure-2} XVI. Notorised Bond of Rs. 7.5 Lakh (Rupees Seven Lakh Fifty Thousand) on a Non- Judicial Bond paper of Rs. 100/- (Rupees Hundred Only). {Format enclosed in Annexure-3}

2 XVII. XVIII. Anti-Ragging Affidavit (print-out) duly Signed. The Candidate should also bring the following certificate, if applicable: a) SC/ ST Certificate issued by the competent authority (in the standard format as specified in the prospectus) and it should be either in English or in Hindi. Sub caste should be clearly mentioned in the certificate. b) OBC certificate issued by the competent authority. The sub- caste should tally with the Central List of OBC. The OBC candidates should not belong to Creamy Layer to claim OBC reservation benefit. The OBC certificate must be in the standard Format as mentioned in the prospectus. c) Orthopedic Physical Disability Certificate issued from a duly constituted and authorized Medical Boards. (Please see clause 11.1 of National Eligibility cum Entrance Test, NEET UG 2013, for admission to MBBS/ BDS Courses, Information Bulletin published by Central Board of Secondary Education for details). No other PH certificate, issued by any other Authorities/ Hospital will be entertained. The qualified Locomotor disabled Physically Handicapped (PH) candidates should get themselves certified at one of the under mentioned Disability Assessment Boards, constituted at the four metro-cities: Vardhman Mahavir Medical College & Safdarjang Hospital, Ansari Nagar, (Ring Road), New Delhi All India Institute of Physical Medicine and Rehabilitation, Hazi Ali Park, K. Khadya Marg, Mahalaxmi, Mumbai Institute of Post Graduate Medical Education & Research, 244, Archarya J.C. Bose Marg, Kolkata- 20. Madras Medical College, Park Town, Chennai (The certificate issued by any other hospital/ board will not be accepted.) The Locomotor Disabled (LD) candidates are required to bring their treatment papers related to their disability, including the investigation reports, at the time of reporting to the above mentioned designated institute to such disability certificate. Physically Handicapped (PH)

3 Anti-Ragging Committee Name Designation ID Contact No. Prof. Sudeb Mondal Dean Dr. K.K. Pal Medical Superintendent Registrar Convener Prof. Joydeb Academic-Nodal Roychowdhury Officer & Dr. Tarun Kr Das Warden (Boys' Dr. Mriganka Baruah Dr. Sudipa Biswas Dr. Saswati Mukhopadhya Hostel) Assistant Warden (Boys' Hostel) Warden (Girls' Hostel) Assistant Warden (Girls' Hostel)

4 Annexure - 2 PROFORMA (Notorised on Non Judicial Bond Paper of Rs.10/-) Bond to be executed by the Candidate for MBBS Course (Session ) at ESI-PGIMSR & ESIC-MEDICAL COLLEGE AND ESIC HOSPITAL & ODC (EZ) I, Sri/Smt. Son/Daughter of Residing at (with contact no.) being selected for MBBS Course (session ) at ESIC Medical College do hereby undertake to pay a sum of Rs. 1,00,000/- (rupees one lakh) only to the Government of West Bengal if I resign or discontinue the course before completion of the tenure of the course (including Internship) prescribed by the Government in pursuance of G.O. No. HF/O/MERT/1542/Admn./ME/STM dated 25 th October Moreover it shall be obligatory on my part to observe or perform all the terms and conditions prescribed by the Government for the aforesaid purpose in future. Signature of the Student in full In presence of Witness :. (Signature)

5 Accepted for and on behalf of the Government of West Bengal Annexure 3 U.G Bond Proforma (Notorised on Non Judicial Bond Paper of Rs.100/-) (For MBBS STUDENTS) WHEREAS the Bounden. has been selected to undergo MBBS in Corporation Medical College in the merit quota for the duration of the course as prescribed by Medical Council of India. AND WHEREAS, the Corporation have agreed to incur the expenses on condition that after successful completion of the course of study within the prescribed period the bounden shall serve the ESI Corporation/ ESI Scheme for a period of five years in any institution of the Corporation/ Scheme anywhere in India, if the Corporation requires and also subject to the terms and conditions hereinafter appearing and the bounden and the sureties have agreed to the same. NOW the condition of the above written obligation is that in the event the bounden after successful completion of the Graduate course of study to which he/ she was selected fails to serve. The Corporation for period of five years, if required by the Corporation, the Bounden and sureties shall forthwith pay to the Corporation for violation of conditions, on demand the total amount of Rs. 7,50,000/- (Rupees Seven Lakh fifty thousand only) the amount spent by the corporation for their studies along with 15% interest as fixed by the corporation. On the quantum of amount payable by the Bounden and the sureties, the decision of the Corporation shall be final and legally binding on the bounden and sureties and upon the payment of such sum the above written obligation shall be discharged. PROVIDED further that the bounden and the sureties do hereby agree that if the Bounden fails to serve the Corporation for a period of five years, if Corporation requires, it may be construed as professional misconduct and the fact reported to the Medical Council of India for suitable action including cancellation of registration by the Council. PROVIDED further that the bounden and the surety do hereby agree that all sums found. Due to the Corporation under or by virtue of this bond shall be recovered jointly and severally from them and their properties movable and immovable as if such dues were arrears of land revenue under the provisions of the Revenue Recovery Act for the time being in force or in such other manner as the Corporation may deem fit. The liabilities of the sureties under this Bond are Co-extensive with that of the Bounden and shall not be affected by the Corporation giving time or any other indigence to the bounden or by the Corporation varying of the terms and conditions herein contained. Signed this day of in the year by the bounden Shri/Smt. In the presence of Witness*. Signature Signed by bounden (Name & Address) (Name & Address with Official Seal) Signed by Shri/Smt. (The Surety)

6 (Name& Address) (Residential Address with Proof is compulsory)

7 TO KNOW ALL MEN BY THESE PRESENTS THAT We.. son/ daughter/ wife of.. residing at (Herein after called the Bounden) And (I) Shri... (Parents/ Guardian) residing at... (Here enter address) (Hereinafter called the surety ) do hereby bind ourselves and each of us, our and each of our heirs, executors and administrators jointly and severally to pay to the Employee s State Insurance Corporation (hereinafter referred to as the Corporation) on demand the total amount of Rs. 7,50,000 (Rupees Seven Lakh Fifty Thousand only) the amount spent by Corporation for their studies with 15% Interest as fixed by Corporation. Signed this day of in the year by the bounden Shri/Smt. In the presence of Witness*. Signature Signed by bounden (Name & Address) (Name & Address with Official Seal) Signed by Shri/Smt.. (The Surety) (Name& Address) (Residential Address with Proof is compulsory) Dean/Administrative Officer of ESIC Medical College/ESI-PGIMSR/Dental College will sign as Witness.

8 Format Admission Form ESIC MEDICAL COLLEGE, JOKA Application Form for MBBS Course 20 Application Form No. Note : Please Read All The Instructions Given In The Prospectus Carefully Before Filling The Application Form Name of Candidate : (As given in Class X Certificate) Father s / Husband s Name : Mother s Name : E Photograph of the Candidate 2. (a) Date of Birth D D M M Y Y Y Y 3. Nationality : 1. All India Quota 4. Gender Male Female 5. Category 2. State Quota 6. Permanent Address : 7. Address for Correspondence :

9 8. STD Code Telephone Number Mobile Number 9. ID 10. Qualification Name of the College and University Signature of the Candidate (Signature of the Candidate) DECLARATION I hereby solemnly and sincerely affirm that the statements made and information given by me in the application form is true and correct. I agree to abide by the Rules, Regulations and Procedures as contained in the information Brochure / Prospectus. I agree to submit all the required original certificates at the time of my selection during admission process as per the rules, failing which my claim for selection shall not be granted. I have not concealed any material, information, however, if any information submitted herein is fraudulent, incorrect or untrue, I understand that I am liable to criminal prosecution and I also agree to forgo my seat in ESIC Medical College, Joka. I understand that the selection and admission to the course is also liable to be cancelled. Date : (Signature of the Candidate) Place :

10 MEDICAL CERTIFICATE ENROLMENT NO. : APPLICATION NO. : OVERALL STATE RANK : I HAVE EXAMINED SRI/SM A candidate for admission into the MEDICAL/ DENTAL DEGREE COLLEGES & observed as follows: 1. Personal Mark of Identification 2. Apparent Age. years 3. Chest measurement a) Normal : cm. b) Full Inspiration : cm. c) Full Expiration : cm. 4. Height.. cm. 5. Weight. Cm. 6. Eye Sight: Right Eye: Left Eye: Colour Blindness: 7. Immunization Status (certificate of Hepatitis B & Tetanus Toxoid)- Optional 8. General Physique: 9. Heart: 10. Lungs: 11. Abdominal Viscera: 12. Blood Group: I do hereby certify that I cannot discover that he/she has any disease constitutional affectional of bodily and mental infirmary.. I consider the above candidate FIT to join his Medical or Dental Institution. Dated (Signature of Registered Medical Officer) (Registration No.- )