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    Form Med0809

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    mahesh
    This document provides instructions for applicants applying for postgraduate medical courses at the National Institute of Mental Health and Neuro Sciences in Bangalore. It outlines 10 instructions that applicants must follow, including filling out the application form in block letters, attaching copies of supporting documents, submitting a recent passport photo, and submitting the application by the due date of November 5th, 2007. It also provides information for applicants who are currently employed or doing internships. Incomplete or late applications will not be considered.

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    Form Med0809

    Uploaded by

    mahesh
    69 views5 pages
    This document provides instructions for applicants applying for postgraduate medical courses at the National Institute of Mental Health and Neuro Sciences in Bangalore. It outlines 10 instructions that applicants must follow, including filling out the application form in block letters, attaching copies of supporting documents, submitting a recent passport photo, and submitting the application by the due date of November 5th, 2007. It also provides information for applicants who are currently employed or doing internships. Incomplete or late applications will not be considered.

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    This document provides instructions for applicants applying for postgraduate medical courses at the National Institute of Mental Health and Neuro Sciences in Bangalore. It outlines 10 instructions that applicants must follow, including filling out the application form in block letters, attaching copies of supporting documents, submitting a recent passport photo, and submitting the application by the due date of November 5th, 2007. It also provides information for applicants who are currently employed or doing internships. Incomplete or late applications will not be considered.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    69 views5 pages

    Form Med0809

    Uploaded by

    mahesh
    This document provides instructions for applicants applying for postgraduate medical courses at the National Institute of Mental Health and Neuro Sciences in Bangalore. It outlines 10 instructions that applicants must follow, including filling out the application form in block letters, attaching copies of supporting documents, submitting a recent passport photo, and submitting the application by the due date of November 5th, 2007. It also provides information for applicants who are currently employed or doing internships. Incomplete or late applications will not be considered.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 5

    Telephone: 080 26995000 - 20 / 26995015 Application for MEDICAL Course

    Fax: 080 26564830 / 26562121


    Grams: NIMHANS PLEASE RETAIN THIS
    SHEET WITH YOU

    NATIONAL INSTITUTE OF MENTAL HEALTH AND NEURO SCIENCES


    (DEEMED UNIVERSITY)
    Post Bag No.2900, Bangalore - 560 029

    INSTRUCTIONS TO THE APPLICANTS FOR POST GRADUATE COURSES

    (Please adhere to the following instructions strictly)

    1. Fill in the application in BLOCK LETTERS (Insert one letter in each block).

    2. Fill in √ where applicable, eg. Mr.X.

    Male Female

    3. Copies of all certificates supporting the claims made in the application must be enclosed.

    4. Affix one recent passport size photograph to the application form on the front page.

    5. Employees of the State Government or of any public undertaking should send the application through
    their employer. However, an advance copy of the application (complete in all respects) can be sent.
    In case the application is not received through the employer before the Entrance Test, a 'No Objection
    Certificate' issued by the employer should be produced at the time of Entrance test, without which
    the candidate will not be permitted to appear for the Entrance test.

    6. Applicants from Foreign Universities/Countries must submit their applications through the Diplomatic
    Channel (through the Ministry of External Affairs).

    7. Candidates who are doing their Internship/Compulsory rotatory job may also apply. But, such
    candidates will be eligible to appear for the Entrance test only if they can produce the proof of
    completing their Internship on on before 2nd May 2008 on the day of Entrance Test. Otherwise, the
    application will be rejected

    8. The last date for receipt of application is 5th November 2007

    9. APPLICATIONS RECEIVED AFTER THE DUE DATE WILL NOT BE CONSIDERED.

    10. INCOMPLETE APPLICATIONS WILL BE REJECTED.

    DOWNLOADED
    DOWNLOADED
    NATIONAL INSTITUTE OF MENTAL HEALTH AND NEURO SCIENCES
    (DEEMED UNIVERSITY), BANGALORE - 560 029

    APPLICATION FOR MEDICAL COURSES

    Application No. Roll No.


    (For Office use only) (For Office use only) Affix recent passport
    Application for admission to (√ in appropriate boxes only) size photograph duly
    DM in Neuroradiology signed by the candidate
    DM in Neurology across the photograph
    M.Ch. in Neurosurgery
    MD in Psychiatry
    Diploma in Psychiatry
    Post Doctoral Fellowship in Neuroanaesthesia
    Post Doctoral Fellowship in Neuropathology
    Ph.D. in
    (Subject) (Signature of the Candidate)
    Name of the Candidate

    Postal
    Address

    P I N
    Phone (Resi) (Off) (Mobile)
    Fax/Email ID

    Permanent
    Address

    P I N
    Father/Guardian/
    Husband's Name
    Occupation Annual Income Rs.

    Mother's Name
    Occupation Annual Income Rs.

    D D M M Y Y Y
    Sex Male Female Date of Birth Age
    Years
    Caste* SC ST OBC Others Nationality Indian Others

    Category Physically Handicapped Yes No If yes, enclose certificate#

    State in which you are domiciled**


    D D M M Y Y Y
    Qualification*** Date of Completion
    of Internship D D M M Y Y Y
    Have you passed the qualifying exam Yes No If no, the date of results

    Are you being officially Sponsored* by State/Central/PSU Yes No If yes, enclose details
    Details of a) Application fee DD No.,Date _________________ Amount _________ Bank _______
    payments b) Registration fee DD No.,Date _________________ Amount _________ Bank _______
    *Relevant Certificates as applicable to be enclosed. **Domicile Certificate to be enclosed if applying for
    #
    Diploma in Psychiatry course. ***Details to be provided in the following pages Refer Prospectus for details
    DOWNLOADED
    Sl. Examination Name of College University/ Date of Date of No. of Aggregate Marks Subjects
    No. Passed and Place Institution Entry Leaving attempts obtained in Final Year Studied

    1 I MBBS
    2 II MBBS
    3 Final MBBS
    Part I
    Part II

    4 M.Sc./MA

    5 Postgraduate
    Diploma
    Diploma Name

    6 Postgraduate
    Degree
    Subject

    (Enclose Copies of Certificates to confirm above statements without which, this would not be considered)

    Whether the college in which you have studied/passed is recognized by Medical Council of India? YES/NO

    Medical Council Registration No, State and year of Registration

    Fellowship from UGC/ICMR/DBT/CSIR YES/NO


    DOWNLOADED
    Declaration by the Applicant

    1. I agree to undergo the course on a full time basis and shall not engage myself in any kind of private
    practice during the period of the course. I will not pursue any part time course elsewhere unless
    permitted by the Institute.
    2. I agree that during my stay at the Institute, I shall not draw my pay/allowances or fellowships from
    any other source if I am employed as a resident.
    3. I declare that I shall abide by the Rules and Regulations of the Institute and those that are framed
    from time to time.
    4. I hereby declare that the information given in this application is true and correct to the best of my
    knowledge and belief. In case any information given in this application proves to be false or incorrect,
    I shall be responsible for the consequences.
    5. I agree that I will not indulge in ragging and am aware that Ragging is banned in this Institution, if at
    any point of time, I am found indulging in Ragging, appropriate punishment may be initiated against me
    including explusion from the Institute.

    Place: (Signature of the Applicant)


    Date:
    Name in Block Letters:

    Declaration by the Parent/Spouse/Guardian of the Applicant

    I hereby declare that I am responsible for the timely payment of all the dues to the National Institute of
    Mental Health and Neuro Sciences, Bangalore in respect of my son/daughter/ward/spouse
    (Name)_________________________________________________ during the period of his/her study at
    the Institute and therefore until the accounts are cleared.

    I am also aware that Ragging is banned in this Institution. Appropriate punishment may be initiated
    against my son/daughter/ward/spouse if found indulging in Ragging including expulsion from the Institute.

    (Signature of Parent/Spouse/Guardian of the Applicant)

    Forwarding note to be signed by the Employer under whom the Applicant is employed

    I certify that the application is being made with my permission and that there is no objection to release
    the applicant if selected for the courses, within the prescribed limit of time.

    I also certify that I shall inform the authorities of the National Institute of Mental Health and Neuro
    Sciences, Bangalore about the financial terms and remit Salary, Leave Salary, Study Leave Salary,
    Deputation Allowances etc. to the Institute Account which will be paid to the applicant for the period of
    this training from the Institute.

    Place: (Signature of the Employer)


    Date:
    Office seal and address of Employer
    NATIONAL INSTITUTE OF MENTAL HEALTH & NEURO SCIENCES BANGALORE-29
    (DEEMED UNIVERSITY)
    ADMISSION CARD FOR WRITTEN TEST
    ENTER PARTICULARS IN CAPITAL LETTERS ONLY
    COURSE APPLIED FOR: DM IN NEURORADIOLOGY, DM IN NEUROLOGY,
    M.Ch. IN NEUROSURGERY, MD IN PSYCHIATRY, DIPLOMA IN PSYCHIATRY,
    PDF IN NEUROANAESTHESIA, PDF IN NEUROPATHOLOGY, Ph.D. in_________
    (STRIKE OFF THE COURSE NOT APPLICABLE)
    1.FullName________________________________________________________________________
    2. Sex : M /F Affix one latest/
    Day Month Year recent photograph
    3. Date of Birth: duly signed by the
    4. You belong to SC / ST / OBC / Others candidate and
    attested by a
    Gazetted Officer

    (For Office use only)


    Application No………………………………………… .Roll No……………………………………

    Signature of the candidate

    (At the examination Center)

    Signature of Candidate Signature of Supervisor

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