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    Nomination Form (Mnams) : (For Diplomate of National Board (DNB) Examination Passed Candidates)

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    Revathy Gunaseelan
    This document contains a nomination form for candidates seeking Membership of the National Academy of Medical Sciences (India) (MNAMS). The form requires information about the candidate such as their name, institution, address, details and year of passing the DNB examination, as well as a proposer who must be a Fellow of the Academy to certify the candidate's character. The form also includes instructions for candidates to enclose documents such as registration certificates and a demand draft of Rs. 7,000 as enrollment fee.

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    Nomination Form (Mnams) : (For Diplomate of National Board (DNB) Examination Passed Candidates)

    Uploaded by

    Revathy Gunaseelan
    79 views4 pages
    This document contains a nomination form for candidates seeking Membership of the National Academy of Medical Sciences (India) (MNAMS). The form requires information about the candidate such as their name, institution, address, details and year of passing the DNB examination, as well as a proposer who must be a Fellow of the Academy to certify the candidate's character. The form also includes instructions for candidates to enclose documents such as registration certificates and a demand draft of Rs. 7,000 as enrollment fee.

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    Mnams nomination form

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    This document contains a nomination form for candidates seeking Membership of the National Academy of Medical Sciences (India) (MNAMS). The form requires information about the candidate such as their name, institution, address, details and year of passing the DNB examination, as well as a proposer who must be a Fellow of the Academy to certify the candidate's character. The form also includes instructions for candidates to enclose documents such as registration certificates and a demand draft of Rs. 7,000 as enrollment fee.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    79 views4 pages

    Nomination Form (Mnams) : (For Diplomate of National Board (DNB) Examination Passed Candidates)

    Uploaded by

    Revathy Gunaseelan
    This document contains a nomination form for candidates seeking Membership of the National Academy of Medical Sciences (India) (MNAMS). The form requires information about the candidate such as their name, institution, address, details and year of passing the DNB examination, as well as a proposer who must be a Fellow of the Academy to certify the candidate's character. The form also includes instructions for candidates to enclose documents such as registration certificates and a demand draft of Rs. 7,000 as enrollment fee.

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    National Academy of Medical Sciences (India)

    NAMS House, Ansari Nagar,


    Mahatma Gandhi Marg,
    New Delhi – 110029

    NOMINATION FORM (MNAMS)


    [for Diplomate of National Board (DNB) Examination passed candidates]
    MEMBERSHIP OF NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) – MNAMS
    Under Regulation V

    I, _____________________________________________________________ [Name of Fellow*]


    Fellow of the National Academy of Medical Sciences (India) propose herein-named candidate for
    admission to the Membership of Academy – MNAMS

    Name of Candidate ______________________________________________________________

    Institution/Hospital of Candidate ____________________________________________________

    Designation _____________________________________________________________________

    Address of Candidate:
    Residence: ______________________________________________________________________

    ____________________________________Tel.No._____________________________________

    Office: _________________________________________________________________________

    ____________________________________Tel.No._____________________________________

    Mobile ____________________________ Email ____________________________________

    Details of DNB Examination conducted by NBE [batch passed NBE held in November, 1992 & onwards]

    1. Year of Passing ____________________________________________________________

    2. Roll No. __________________________________________________________________

    3. Subject ___________________________________________________________________

    This is to certify that I have known Dr. _______________________________________________


    for the last ______ Years. To the best of my knowledge, he/she bears good character and is fit for
    admission to the Membership of the National Academy of Medical Sciences – MNAMS.

    Signature with date_________________________


    Proposer _________________________________
    (Name in block letters)
    Address ________________________________
    ________________________________
    *Only Fellows of the Academy are entitled to sign the certificate
    To be filled in the Office of the Academy

    (a) Sl. No. of the Proposal___________________________________________

    (b) Date of receipt of Proposal_______________________________________

    (c) Proposal scrutinized by_________________________________________

    (d) Date of approval by the Council___________________________________

    (e) Date of Informing the candidate___________________________________

    (f) Date of receipt of enrolment/fee and Life Subscription_________________

    (g) Date of award of the Scroll_________________________________________


    BIODATA of the Candidate applying for admission to the
    “Membership of the National Academy of Medical Sciences (India) -
    MNAMS” (under Regulation V of the Memorandum of Association,
    Rules and Regulations). Photo Attested
    by
    the Proposer
    to be pasted here

    1. (a) Name ___________________________________________________________________


    Surname First Name Middle Name

    (b) Sex_____________________________________________________________________

    (c) Date of Birth_____________________________________________________________

    (d) Nationality_______________________________________________________________

    2. Institutional/Hospital Affiliation_________________________________________________

    ___________________________________________________________________________

    3. Mailing address:-_____________________________________________________________

    (a) Office___________________________________________________________________

    (b) Residence________________________________________________________________

    (c) Phone No. with S.T.D. Code Res.____________________Office___________________

    4. Name of State to which the candidate belongs______________________________________

    5. Registration:

    (i) M.C.I. Year__________________Number_______________


    OR
    (ii) State Medical Council Year__________________Number_______________
    (Please attach an attested/self-attested copy of the registration certificate)

    6. Particulars of passing the DNB Examination conducted by the National Board of Examinations:

    (a) Year of Passing the Examination_______________________________________________

    (b) Roll No.__________________________________________________________________

    (c) Subject___________________________________________________________________

    (Please attach an attested/self-attested copy of the diploma certificate of NBE)


    7. Professional Examination passed
    _______________________________________________________________________________
    Name of Examination Year University/College
    _______________________________________________________________________________

    (a) MBBS Final

    (b) Postgraduate
    Examination

    (i)

    (ii)

    * [Please attach all attested/self-attested copies of certificates incld. MBBS Degree / Registration
    of MCI or State Medical Council and DNB Passing Certificate (Final/Provisional)]

    Date_________________________ _____________________
    (Candidate’s signature)

    List of enclosures:

    Instructions:

    1. A Bank Demand Draft of Rs.7,000/- (Rs. Seven Thousand Only) in favour of the “The
    Secretary, National Academy of Medical Sciences (India)”, payable at New Delhi may be
    enclosed.

    2. Candidates who have already applied for Membership (MNAMS) or admitted as Member
    need not apply again.

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