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 PARTICULARS NO Requisition letter addressed to the Principal, KAiMS, Karwar 1 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 10 th marks card / 10 th passing certificate 8 12 th marks card / 12 th passing certificate Students claiming reservation under Hyderabad-Karnataka region (article-371j) shall submit 9 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) Migration certificate from the board if passed 12 th standard from the board (other than 18 Karnataka PU board) 19 Physical fitness certificate (Medical certificate) 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 20 50% and more than 40% marks in 10+2 (PCB) examination required for submission to MCI, New Delhi. 21 22 23 24 25 26 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. 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). 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). Undertaking: - MBBS degree programme as per RGUHS curriculum - to be typed in Rs. 50/-Estamp paper. and duly attested by notary (proforma given below). 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). 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) Place: Karwar (Signature of the parent / Guardian) 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) Place: Karwar (Signature of the parent / Guardian)
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 6 Nationality 7 Allotment / Rank Details 8 Marks Scored in CET/AIQ (Enclosed Details ) Qualifying Exam Register No in PUC / 12 th Class PUC / 12 th Class Passed Year Specify the name of the University / Board where you have studied PUC / 12th STD. Religion : Caste : Category : CET NO : RANK : AIQ : RANK : Exam Passed CET AIQ Max Marks Marks Obtained Date Month Year % of Mark s Total marks scored in optional subjects in PUC / 12 th 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 / 12 th 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 Date: Signature of the candidate: 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 :- 2. Witness (Signature & Address) 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 THE GOVERNMENT NOTARY TO BE TYPED IN RS.100/- E-STAMP PAPER
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. Witness: Signature of the student with full address 1. 2. SEAL & SIGNATURE OF THE GOVERNMENT NOTARY TO BE TYPED IN RS.50/- E-STAMP PAPER
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. Signature of the candidate Signature of the Parent (Father / Mother) Date : Place : SEAL & SIGNATURE OF THE GOVERNMENT NOTARY TO BE TYPED IN RS.100/- E-STAMP PAPER
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. To: The Above Candidate Principal, Karwar Institute of Medical Sciences, Karwar
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 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 7 10 th marks card / 10 th passing certificate 8 12 th marks card / 12 th passing certificate Students claiming reservation under Hyderabad-Karnataka region 9 (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) Eligibility certificate from RGUHS (for students other than 16 Karnataka PU board) 17 Migration certificate from the university last attended (if applicable) Migration certificate from the board if passed 12 th standard from the 18 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. Annexure I, part II: - undertaking by parent/ guardian - to be typed in 23 Rs.100/- E-stamp paper. Undertaking:- MBBS degree programme as per RGUHS curriculum 24 - to be typed in Rs. 50/- E-stamp paper. Execution of rural service bond by candidates who select MBBS seats 25 in KAiMS, Karwar to be typed in Rs. 100/- E-stamp paper. Four (04) recent color digital passport size photographs one single file with latest photograph affixed on it including name and address 26 of the candidate NOT SUBMITTED NOT APPLICABLE Place: Karwar Date: Signature of the Candidate: 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 : directorkarwarmc@gmail.com 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