5-6 Regn. No. FOR OFFICE USE ONLY 1. Name of Candidate :. Category : 3. Whether Arts/Science Candidate : 4. First or Second attempt in AISSCE : Initial of the DA/OS Note : Since the application is invited through online, this form is to be filled in by the applicant very carefully by reading the instructions given below and the annexure/instructions given in the website. INSTRUCTIONS 1. The candidates should submit their application online at http://ls1.and.nic.in/seatallotment. The online application will be accepted from 16-06-5 to 30-06-5 upto 5.00 p.m. 3. The candidates those who have passed + exam from the National Institute of Open Schooling (NIOS) or Other State Board are requested that before filling their ONLINE application, they may approach the Assistant Secretary (Hr Edn), A&N Administration, Secretariat, Port Blair for conversion of marks at par with CBSE. 4. The candidates should provide all the mandatory details in the online portal failing which the application will not be accepted by the online website. It is also advised to enable Javascript in the browser such as Internet explorer, Firefox, Google chrome etc to successfully upload your online application. 5. Candidates shall indicate the choice of Discipline/Course codes for which they would like to be considered for allotment of seat as per Annexure A. 6. Category of the candidate in support of the certificate is to be recorded as per the category code given in Annexure C. 7. Incomplete applications will summarily be rejected. Incorrect, illegible and misleading entries will also lead to rejection of application. 8. If the information furnished by the applicant is found incorrect at the later stage, his/her candidature/nomination will be cancelled. 9. Nominations issued by the Administration will be valid, subject to fulfilling admission criteria/requirements of the Institutions/University by the applicant concerned. 10. Provisional Merit list, Final merit list, list of selected candidates etc. will be displayed on the Notice Board of the Secretariat as well as in the website of A&N Administration from time to time. General Information thereof will be announced through All India Radio, Port Blair and in The Daily Telegram. 11. Attested copies of the required certificates are to be attached with the downloaded application. 1. Candidates allotted with engineering seat in National Institute of Technology (NIT) shall not be eligible for Administration seat i.e. they will be eligible for any one seat either NIT or Administration seat. 13. The candidates shall be called for counseling on a fixed date, which shall be notified through All India Radio, Port Blair and in The Daily Telegram as well as in the website of A&N Administration. No individual communication shall be sent regarding date of counseling. 14. The seat shall be allotted during counseling. 15. The candidates shall be called as per the merit in different categories during counseling and asked to exercise their preference. 16. All the candidates should have appeared/qualified Andaman Nicobar Islands Pre Medical Entrance Test (ANIPMT)-5 to be conducted by Health Department/ANIIMS of the Administration for allotment of Central Pool MBBS and BDS seats reserved for the students of A&N Islands if any allocated by the Ministry of Health & Family Welfare. The said MBBS and BDS seats under Central Pool quota will be allotted category-wise (as per Annexure-'C') based on the marks/rank obtained by the candidate from A&N Islands in ANIPMT-5. 17. Once a seat has been allotted to the candidate after exercising his/her preference during counseling, he/she is not eligible for any other seat or to change his/her preference. 18. Merit lists for the different Discipline/Course shall be prepared based on the criteria fixed by the Institute/Govt. of India/State Govt. 19. The marks obtained by the student in practical examination will not be counted while preparing Merit list for allotment of reserved seats in professional, technical and non-technical courses on the mainland institution/colleges. 0. The website will also allow the applicant to take print out of the submitted application. Thereafter (a) put his/her signature by giving declaration provided in the Application form.
1. Online submitted application forms downloaded from internet alongwith attested copies of certificates should be submitted in person or through the authorized person or by post to the Development-IV Section, Secretariat, Port Blair during working hours on or before 30/06/5 positively. No application will be accepted after 5.00 p.m. on 30/06/5 under any circumstances. Copy of score card/ranking of ANIPMT-5 is to be submitted in person or through the authorized person or by post to the Development-IV Section, Secretariat, Port Blair within Seven working days after declaration of result of ANIPMT-55.. The Assistant Secretary (Hr Edn), A&N Administration, Secretariat has been nominated as a Nodal Officer for this purpose. Further details in this regard, if any, can be obtained from the Assistant Secretary (Hr Edn) either in person or over telephone number 0319-31158. 3. No TA/DA will be paid to any candidate by the Govt. for their Journey/stay. 4. All the candidates should have qualified the Entrance Exam-5 conducted by Regional Institute of Education for allotment of Central Pool B.Sc.B.Ed seats reserved for the students of A&N Islands if any allocated by the Ministry of Human Resource Development. The said B.Sc.B.Ed seats under Central Pool quota will be allotted category-wise (as per Annexure-'C') based on the marks/rank obtained by the candidate from A&N Islands in the Entrance Exam-5 Note : As per the direction of the MHRD vide letter dated 0.05.5, the allotment of 105 degree level engineering and architecture seats reserved at mainland institutions for the students of A&N Islands will be done by Central Seat Allocation Board-5. Therefore, the students and parents are requested to be prepared for the new procedure regarding allotment of aforesaid seats. In case if any change at later stage in regard to the procedure for allotment of 105 degree level engineering and architecture seats, the same will be intimated to the general public through print media and electronic media.
3 APPLICATION FORM FOR ADMISSION IN PROFESSIONAL/ TECHNICAL / NON TECHNICAL COURSES FOR POST SECONDARY / SENIOR SECONDARY STUDIES IN INSTITUTION / UNIVERSITY ON THE MAINLAND FOR THE YEAR 5-6 (Note : Please read carefully the instructions given on front page for filling up this form) 1. Discipline/Course for which candidate shall like to be considered (Refer Annexure A for Discipline/Course code):.(a) Whether the candidate had on earlier occasion been ( Y-Yes, N-No ) nominated for any course by the Administration? (b) If Yes, please furnish (i) Course Code: (ii) Name of the Institution (Also attach copy of Nomination) 3. Have you appeared for ANIPMT-5 (Y-Yes, N-No) If yes, (a) Roll No. of ANIPMT-5 (i) Rank obtained in ANIPMT-5 (copy of score card/ranking to be attached) (ii) Marks Obtained in ANIPMT-5 4.(a) Name of the Candidate in full (IN BLOCK LETTER) (b) Sex (c) Married ( ) (M-Male-F-Female) Unmarried 5.(a) Name of the father/guardian (b) Name of mother (c) Postal address for Corresponddence Telephone No. if any 6. Permanent residence, Village, Post office, District and State 7. Date of Birth (Birth proof to be attached) DD MM YY 8. Nationality: 9. Whether Person with disability: Yes No (a) If yes, nature and percentage of disability: %
10. Category to which candidate belongs: (Refer Annexure C for Category Code) (Certificate to be attached in the prescribed form) 11. State to which the candidate originally belongs: 1. Educational Qualifications : (a) (i) Name of Board/University from which the candidate passed his/her AISSCE 4 (ii) Duration of study in these islands Years Months (iii) Qualifying Examination passed (b) Year of passing of qualifying examination (c) Whether the qualifying examination passed at first attempt ( Y-Yes; N-No) If not, in which attempt? (write 1 for 1 st attempt, for nd attempt and so on) 13. Details of Marks secured in AISSCE (Class XII) Roll No... Sl.No Subject Maximum Marks obtained. Marks Theory Practical Total 1. English. Physics 3. Chemistry 4. Biology 5. Mathematics 6. Computer Science 7. Hindi 8. Economics 9. History 10. Geography 11. Political Science 1. 13. 14. Gross Marks Percentage of selected five subjects: % 14. Details of Marks secured in AISSE (Class X) for Diploma Courses Roll No... Sl.No Subject Maximum Marks/ Marks Obtained/ Grade Point Grade Point 1. English. Hindi 3. Mathematics 4. General Science 5. Social Studies 6. Total Marks Percentage of Marks/ Cumulative Grade Point Average %
5 15. Details of any other Examination passed:- (a) Degree of any University :...... (b) Name of College/University from :....... where the Exam passed (c) Subject (d) Percentage of Marks obtained (e) Division secured :...... :...... :...... 16. Have you appeared the entrance Exam conducted by Regional Institute of Education for admission to B.Sc B.Ed Integrated course: ( Y-Yes; N-No) (a) If yes the marks/rank Obtained : 17. Does the candidate/guardian have financial :...... capability to undertake the proposed course without any other financial help from outside, if nominated. DECLARATION [ I,...hereby declare that the particulars furnished above are complete and correct to the best of my knowledge and belief. In the event of any information found false or incorrect or ineligibility being detected before or after the admission, an appropriate action, as deemed fit, can be taken against me. UNDERTAKING (Signature of applicant) Undertaking to be produced by the candidates who have appeared in JEE (Main) for NIT seat I am aware that a candidate is eligible for allotment of only one seat. I shall not be eligible for a seat from Administration quota in case I am allotted a seat from NIT quota. Similarly, if I am allotted a seat from the Administration quota, I shall not opt for/ be eligible for a seat from NIT quota. Certificate No. 1 (Signature of applicant) (i) Certificate to be produced by Scheduled Tribe candidate under Category-I (In the absence of Caste Certificate) Certified that Shri/Kumari... S/o. D/o..... is Scheduled Tribe Candidate belonging to tribe. Certificate No. Assistant Commissioner/Tehsildar) (Affix Seal) (i) Duration Certificate to be produced by the students under Category IV Certified that Shri. /Kumari... S/o,D/o.. R/o.., A & N Islands and he/she studied for a period of 10 years in Andaman and Nicobar Islands from......to... in......... School and from...to...... in.........school. Principal Govt. College/ Principal S.S. School/ Head of Institution (Affix Seal) Note: Students under category I, III & IV mentioned at annexure-c are to be furnished the category certificate in support of their Category. In case, the candidate belonging to Category-I do not have acquire the category certificate should submit the declaration under Certificate-1 duly signed by the Assistant Commissioner/Tehsildar. Similarly, in case the candidates belonging to Category-IV do not have acquire the category certificate should submit the declaration under certificate- duly signed by the Head of the Institution/School.
6 Certificate No. 3 (iii) Certificate to be produced by the candidates of the Central Govt. Employees / Deputationists from the Head of the Department/offices under Category-II Certified that Shri/Smti...... F/o/M/o Shri/Kumari........ is a Central Government Employee/Deputationist and is working at present/was working when his/her son/daughter appeared in the qualifying examination from a school in the Island i.e......... in the capacity of...... with transfer liability to serve outside the Union Territory. Head of the Department/Office (Affix seal) Certificate No. 4 (iv) Duration Certificate to be produced by the candidates of the Central Govt. Employees/Deputationists for considering under category II & V. Similarly, the students under Category I, III & IV may also submit the certificate for considering seat under Category V (General Merit). Certified that Shri / Kumari... S/o., D/o...... R/o... has studied last years i.e. from..... to....... and passed the qualifying examination from...schools in Andaman and Nicobar Islands. Principal Govt College / Principal S.S. School / Head of Institution (Affix seal) The following attested copies of certificates are to be attached with the downloaded application. a) Certificate of passing AISSCE (Class XII) with Statement of Marks. b) Certificate of passing AISSE (Class X) with Statement of Marks. c) Date of Birth Certificate. d) Migration Certificate e) Copy of score card/ranking in respect of ANIPMT-5 appeared by the candidate. f) Degree certificates, if any. The following attested copies of certificates are also to be attached in support of their claim for respective category:- 1. For Category I (Tribal) Caste Certificate/Certificate No. 1 & Certificate No. 4. For Category-II (Deputationists/Central Govt. Employees) Certificate No. 3 & 4 3. For Category III A (Pre-194 settlers) Local Certificate issued by the Revenue Authority and Certificate No. 4 4. For Category III B (Other settlers) Local Certificate issued by the Revenue Authority and Certificate No. 4 5. For Category-IV (10 years continuous education in the Islands) Local Certificate/Certificate No. & Certificate No. 4 6. For Category-V (General Merit) Certificate No. 4
7 ANNEXURE-A DISCIPLINE/COURSE CODES NAME OF THE DISCIPLINE/ COURSE BRANCHES UNDER DISCIPLINE/COURSE (along with tentative no. of seats for each course/branch) DISCIPLINE/COURSE CODES MBBS - MBBS (13) BDS - BDS (0) 0 BAMS - BAMS (03) 03 BHMS - BHMS (0) 04 Hotel Management - Hotel Management (10) 16 Year Craft Course - Year Craft Course (10) 18 Printing Technology and Photography - Printing Technology () - Photography () 3 Diploma -1 (For + passed candidates with PCM) Diploma - (For + passed candidates with PCB) Diploma -3 (For Class Xth passed candidates) - Electronics & TV (0) 9 - Textile Process () - Cinematography () - Pharmacy (08) 30 - Production (0) - Electronics & Telecommunication (0) - Man Made Fibre Technology (0) - Architecture (03) - Industrial Electronics (07) - Electronics & Communication (0) B.Sc.B.Ed - B.Sc.B.Ed (03) 56 B.L. Integrated Course - B.L. Integrated Course (0) 6 General Nursing - General Nursing (1) 63 B.Sc.(Nursing) - B.Sc.(Nursing) (0) 64 Para Medical Course - Medical Lab. Tech.(0) 65 - Radiological Assistant () - Ophthalmic Assistant () - Dental Mechanic () B.Sc Agriculture B.Sc Agriculture (08) 81 B.Sc.Horticulture B.Sc.Horticulture (05) 8 No. of seats specified are tentative and based on last year s allotment ANNEXURE B Provisional/Tentative List of Professional/Technical/Non technical Institutions where seats were made available during 4-5 (Subject to change during the 5-6) Course Name of the Course Name of Institutions/Directorate of Tech. Education No. of seats Code available MBBS Medical College, Kottayam, Kerala Medical College, Alapuzha, Kerala Medical College, Kozhikode, Kerala BRD Medical college, Gorakhpur, UP KG Medical College, Lucknow, UP 0 Burdwan Medical College, W/Bengal 0 B.S. Medical College, Bankura, W/Bengal 0 North Bengal Medical College, Darjeeling, W/Bengal Lady Hardinge Medical College, New Delhi 0 0 BDS Govt. Dental College, Aurangabad, Maharashtra K.G.Medical College (Dental Wing), Lucknow, UP 03 BAMS Govt. Ayurvedic College, Osmanabad, Maharashtra MMM Govt. Ayurvedic College, Udaipur, Rajasthan Anantalaxmi Govt. Ayurvedic College, Warangal 04 BHMS National Institute of Homeopathy, Salt Lake City, Kolkata -4 D.N.De Homeopathic Medical College, Kolkata, WB 16 Hotel Management Institute of Hotel Management, Catering Technology & Applied 10 Nutrition, CIT Campus, Chennai-6013 18 Year Craft Institute of Hotel Management, Catering Technology & Applied 10 Course Nutrition, CIT Campus, Chennai-6013 3 Printing Technology and Photography Regional Institute of Printing Technology, Raja S.C.Mullick Road, Jadavpur, Kolkata-70003 9 Diploma -1 (For + passed candidates with PCM) 30 Diploma - (For + passed candidates with PCB) 34 Diploma -3 (For Class Xth passed candidates) The Secretary, Govt. of Tamil Nadu, Fort St. George, Chennai-600009 (Textile Process-1) DTE, Govt. of Haryana, Chandigarh-1600 (Electronics & TV-) The Secretary, Govt. of Karnataka, Bangalore-5600 (Cinematography-1) The Directorate of Technical Education, Maharashtra State, 3-Mahapalika Marg, Dhobi Talao, Mumbai-4000 (Pharmacy-8) The Secretary, Govt. of Tamil Nadu, Fort St. George, Chennai-600009 (Architecture-3, Electronics & Communication-, Man Made Fibre Technology-, Production-) The Addl. Director of Tech. Education & Training, Govt. of Orissa, Cuttack-7530 (Electronics & Telecommunication-) The Directorate of Technical Education, Maharashtra State, 3- Mahapalika Marg, Dhobi Talao, Mumbai-4000 (Industrial Electronics-7) 56 B.Sc.B.Ed Regional College of Education, Bhubaneshwar, Orissa 3 34 1 1 8 9 7
8 6 B.L. Integrated Dr. Ambedkar Govt. Law College, Puducherry Course 63 General Nursing Bowring and Lady Curzon Hospital, Bangalore The Dy. Director of Health Services, General Nursing, Kolkata Directorate of Health Services, Trivandrum 5 5 64 B.Sc.(Nursing) College of Nursing SSKM Hospital, Kolkata Directorate of Medical Services, Trivandrum 1 1 65 Para Medical Directorate of Health Services, Trivandrum 5 Course (Medical Lab Technology-, Radiological Asst-1, Opthalmic Asst-1, Dental Mechanic-1) 81 B.Sc Agriculture Agri. College & Research Institute, Coimbatore, T/Nadu Agri. College & Research Institute, Madurai, T/Nadu. Agri. College & Research Institute, Killikulam, T/Nadu. Anbil Dharmalingam Agri. College & Research Institute, Tirchy, T/Nadu. 8 B.Sc.Horticulture Hort. College & Research Institute, Periyakulam, T/Nadu 5 ANNEXURE C GOI, M.H.A, New Delhi s order No. U-14040/5/96-ANL dated 30 th May 1996 Category of Candidate Description of Category Category Code Category I Tribals 0% Category II Category III Deputationists and Central Government employees with transfer liability to serve outside the Union Territory provided the candidates in this category have studied the last two years in the islands and passed the qualifying examination from a school in the Islands. Settlers who were settled prior to 194 and those who were settled under various rehabilitation schemes introduced after re-occupation of the Islands. The seats in this category will be allocated as under:- (a) Pre-194 Settlers 10% 0 50% 1/3 rd 3A (b) Others Settlers 1/3 rd 3B Category IV Category V (c) Seat to be allocated on the basis of combined merit of (a) & (b) above Other locals who do not fall under (I) (II) or (III) above and such Central Government Employees having no Transfer liability to serve outside the Union Territory, provided all have had 10 years education in the islands. General merit quota opens to all the residents of A&N Islands irrespective of any classification. This will be subject to condition that the candidates in this category have studied the last two years in the Islands and passed the qualifying examination from a school in the islands. 1/3 rd 3(A+B) 0% 04 Un-utilized seats of Categories I,II,III&IV 05