Cost:-: Rs. 2000/- Attested Photograph. 1. UG NEET-2017 Roll No. : Marks: / 2. Name of the Candidate. 3. Sex : 4. Father s Name. 5. Mother.

Transcription

1 Cost:-: Rs. 2000/- 1 Baba Farid University of Health Sciences FARIDKOT Application Form for admission to MBBS/BDS course (NRI quota) (For Govt/University/Private Colleges/Private Universities/Minority Institutions for Session- 2017) Closing date for submission of Application Form_ _ with a fee of US $ 1000 for MBBS/BDS (or equivalent in Indian Rs.) 1. DD/Banker Cheque : (Amount & Number) 2. Course : 3. Category : Attested Photograph 1. UG NEET-2017 Roll No. : Marks: / 2. Name of the Candidate M F Date of Birth (dd/mm/yy) 3. Sex : 4. Father s Name s Name 5. Mother 6. Name of the Guardian: (in case of Father/ Mother not alive)

2 2 7. Permanent Address in India 8. Postal Address Abroad Telephone No. (In India) & Mobile No. (Abroad) Fax No. (In India) (Abroad) E- Mail Address 9. (i) Examination passed 10+1/equivalent in the year under Roll No. from the University/Board/Institution (ii) Examination passed 10+2/equivelent in the year under Roll No. from the University/Board/Institution Subjects Marks/Grade Obtained Maximum Marks English Physics Chemistry Biology Total(PCB) Total(PCBE) (iii) Name of the School/College/university (iv) Whether the institution is recognized/ accreditated? Yes/No (Please attach certificate, if yes) (v) Whether University/ Board is recognised Yes/No (Please attach Proof)

3 3 9. NRI Seats are in the following order of priority to the exclusion of next category. Category I : NRIs who originally belonged to the State of Punjab. Category II : NRIs who originally belonged to an Indian state other than Punjab. Please fill in appropriate applicable category in the box. For determination of appropriate category applicable. NRI Category under which applying (Please indicate the appropriate category) a) Candidates are required to attach the following documents/proof as is applicable in their respective case: i) Photocopy of candidate's passport ii) Photocopy of parents passport I hereby solemnly declare that the statements made herein above are true to the best of my knowledge and belief. Should the said information prove to be incorrect at any stage, my candidature/admission to the MBBS/BDS course shall stand cancelled. Signature of the Father/ Guardian of the candidate Signature of the candidate Date Place Enclosures Attested Copies 1. Copy of UG NEET-2017 Admit Card and Result Card. 2. Copy of the certificate qualifying examination certificate. 3. Statement of Marks/ Detail Marks Certificate of 10+2 or equivalent examination. 4. Pass Certificate/Diploma of 10+2 or equivalent examination DMC. 6. Detail of Grades of qualifying examination. 7. Eligibility Certificate indicating equivalence of 10+2 from Baba Farid University of Health Sciences, Faridkot. 8. Date of Birth certificate 9. Character/Conduct certificate from the institution last attended. 10. The candidate applying under category (I) & II are required to submit a. Photostat Copies of the passport etc. of Father/Candidate. b. Proof of having ancestral background of Punjab/other than Punjab. 11. Demand Draft/ Cashier s Cheque for US $ 1000 or equivalent in Indian Rupee. 12. Provisional Student Visa, if required.

4 4 For use by the Selection Committee: Recommendation I Shri/Ms. has been allotted a NRI seat at for which full fee/ist instalment has been deposited on the spot and he promises to submit Bank Guarantee for the balance fee at the college with in a weeks time. Statement of the candidate: 1. I have been offered a NRI seat at which I have accepted. Payment of US $ /Rs. in Indian currency (full fee/ist Instalment) has been paid by me. I undertake to submit the Bank Guarantee for payment of remaining instalments of fee (in case of payment by instalments) within a week to the concerned Principal. I fully understand that my failure to deposit the balance instalments or submission of bank guarantee in lieu thereof shall deprive me of my claim of admission to MBBS/BDS course. 2. I also wish to be placed on the waiting list for course and should a vacancy arise in the said college, I may be considered for the same. Signature of the Father/ Guardian Signature of the Candidate

5 5 Recommendation II Shri/ Ms. a candidate for admission to MBBS/BDS course presented himself/herself before the Selection Committee. He/She could not be allotted seat for following reasons:- a) All the available NRI seats stand allotted to the candidates with higher merit. However, on his/her request, his/her name has been placed in order of preference on the waiting list for i), ii),iii). Should a seat be offered to him/her as a consequence of a vacancy arising in NRI seat, the candidate is bound to join the allotted college within one week of the receipt of offer failing which the offer of admission shall be deemed to be cancelled. b) NRI seat was offered to him/ her at and he/ she refused to accept the same and wished to be placed in order of preference on the waiting list for MBBS/BDS course(nri seat) at i) ii) iii) Should a seat be offered to him/her as a consequence of a vacancy arising in the course in NRI category arising at later date, the candidate is bound to join the allotted college within one week of the receipt of the offer, failing which his/her claim for admission to MBBS/BDS under NRI quota will get extinguished. Statement by the candidate I wish to be placed in order of preference on the waiting list for an NRI seat in MBBS/BDS at the following institutions: In case a seat at one of the above colleges is offered to me and I don t join within one week of receipt of the offer, I understand that my claim for admission against NRI quota gets extinguished. Signature of Father/ Guardian Signature of the candidate

6 Recommendation III 6 Shri/Ms., a candidate for admission to MBBS/BDS course under NRI quota presented himself/herself before the Selection Committee. a) He/She refused to be considered for admission. b) He/She refused to be considered for inclusion in the waiting list for MBBS/BDS (under NRI category) at,,. Hence his/her case for admission stands closed. Statement of the candidate 1. I was offered an MBBS/BDS seat under NRI quota at, which I have refused to accept. 2. I am not interested to be placed on waiting list for MBBS/BDS admission under NRI category. Signature of Father/ Guardian Signature of Candidate Recommendation IV Sh./Ms. who presented for admission to MBBS/BDS under NRI category could not be considered owing to following deficiency(ies). His/Her case for admission to MBBS/BDS course is, therefore, closed.