Sanjay Gandhi Postgraduate Institute of Medical Sciences

Raebareli Road, Lucknow 226 014

FAX: 91-522-2668017, 2668129 Phones: 91 (522) 2494304
Email: erexam@sgpgi.ac.in 2495511, 2494009
Information regarding joining procedures and formalities for residents
(MD/DM/MCh/SR-HS/PDC/MPR) and Demonstrators

Welcome to SGPGI. Please download and read this document carefully.

Print this entire document back to back (i.e. using both sides of paper) and fill the relevant portions.
At the time of joining, the administration will need to see all original documents, as listed in letter of
offer of appointment. Please also bring along one photocopy for each document and at least 6
passport-size photos. Without the above, you will not be able to join.
Annex Description Instructions
No
The following forms need to be submitted at the time of Fill these, & have
joining: Annex 2 attested from
1 Marital declaration form your usual place of stay /
2 Character certificate from two authorized persons most recent employer

After your documents have been verified, these need to be

filled
3 Medical Examination form Familiarise yourself
4 Joining report form with these forms as this
5 Hostel accommodation form will be required of you
6 Document submission form (Only for MD, DM/MCh programs)
The following documents are filled after joining
7 Medical facility and declaration of dependents Familiarise yourself and
8 Library form fill out relevant portions
9 Email / HIS form in advance
10 Identity card form
11 Wi-Fi form for residents

Reach 1st floor of the Administrative Block Room No. 217 (between 10AM to 4 PM) and meet Mr.
Mohit Srivastava, LDA, Residents Section (Tel 0522-249 5266). He will debrief you and help out
with forms as required.

Prior to start Medical examination candidates it is best you start early in the day (around 10 AM). You
need to go to the departments of Pathology, Radiology and Ophthalmology in the Main Institute
building and thereafter to the General Hospital for assessment by Physician, Surgeon and
Gynecologist (for women). After all tests and assessments, The Medical Superintendent available in
the office located adjacent to the atrium of the old OPD building will sign the medical fitness
certificate.

After clearance from the Medical Board, please report back to Mr. Mohit Srivastava in the
Administrative Block who will then authorize you to collect fee book from Junior Accounts Officer
(Research), Room no. 209 -B, First Floor. The requisite fee, as laid down in your appointment letter /
prospectus, is to be deposited with the State Bank of India, SGPGI Branch as per details available in
the fee book. This can also be done online through the SGPGI portal www.sgpgims.org.in
(Online deposit: Course fee) or directly at
https://www.onlinesbi.com/prelogin/icollecthome.htm?corpID=258357

1
After depositing the fees, please report again to Mr. Mohit Srivastava (in the Residents Section).

Your joining formalities at this stage will include completion of all documents and verification of
original documents. You may also need to deposit some of your original documents, if applicable.

In case of any difficulty, you may approach Dr. Shalini Singh, Sub-Dean (Student Affairs) / Dr.
Prabhkar Mishra, Sub-Dean (Exams) or Lt. Col. Varun Bajpai, ER in that order.

Once your joining is accepted in the Administrative Block and the joining letter is signed by the
Executive Registrar, you will be asked to report to the Head of the department (HOD) in which you
have been appointed, along with the joining report. This is to be signed by the HOD and submitted
back in the administrative block to Mr. Mohit Srivastava.

We hope you have a pleasant and fruitful stay at SGPGI.

2
 MARITAL DECLARATION Annexure 1
(Please tick the relevant portion and strike out the portions not applicable)
I, Dr………………………………………………. declare as under:

(i) That I am Bachelor/ Widower /Married/Divorced.

(ii) That I am married and have only one husband/wife living
/ that I am married to a person who has no other wife living.

(iii) That I am married & have more than one wife.

(iv) That I am married to a person who has another wife living.

In case of (iii) or (iv) above:

I request that in view of the reasons stated below, I may be granted exemption from the operation
of restriction on the recruitment to service of persons having more than one wife living or having
married to a person having more than one wife living.

I solemnly affirm that the above declaration is true & I understand that in the event of the
declaration being found to be incorrect after my appointment, I shall be liable to be dismissed from
service.

Date: …………………………………. Signature ……………………………………

 Annexure 2

This certificate needs to be issued / signed by two separate officers

CERTIFICATE OF CHARACTER

Certified that I have known Dr…………………………………………………son/daughter of

Shri…………………………………… for the last……………years……………. months and, to the
best of my knowledge & belief, he/she bears reputed character & has no antecedents which render him
unsuitable for employment at SGPGI, Lucknow.

Dr……………………………………………………………is not related to me.

Place:……………………………………….. Signature………………………………………………
Dated:………………………………………. Designation……………………………………………

District Magistrate or Sub-Divisional

Magistrate or Gazetted Officer

CERTIFICATE OF CHARACTER

Certified that I have known Dr…………………………………………………son/daughter of

Shri…………………………………………………for the last……………years……………. months
and, to the best of my knowledge & belief, he/she bears reputed character & has no antecedents which
render him unsuitable for employment at SGPGI, Lucknow.

Dr……………………………………………………………is not related to me.

Place:……………………………………….. Signature………………………………………………
Dated:………………………………………. Designation……………………………………………

District Magistrate or Sub-Divisional

Magistrate or Gazetted Officer
Annexure 5
MEDICAL EXAMINATION FORM for joining
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow
Declaration by the candidate
I hereby declare that I am not suffering from any disease including bodily deformity, infectious
disease, chronic illness such as hypertension, diabetes etc. I also declare that I have not been
considered medically unfit by any medical authority in the past.
OR
I declare that I have been suffering from ………………………………………………………
for the last …………… years.
(If not suffering from any illness, state ‘no illness’. This portion can not be left blank. Suppression of
information about past illness will invite suitable disciplinary action)

Name __________________________ Signature ______________________

Designation _____________________ Dated _________________________

MEDICAL EXAMINATION
Height (cm) …………………….. Weight (Kg) ……………..
Apparent age (years) …………… Pulse (/min) …………….. BP (mmHg) ………………
JVP …………………………….. Edema feet ……………… Varicose veins …..……………..
CVS …………………………….. Chest ……………………. CNS ……………………………
Abd …………………………….. Genitalia ………………… Hernia/hydrocele ………………

Gynaecological assessment: Married /unmarried Children ………………………..

LMP …………………………….. P/A ………………………. P/V ……………………………..

Ophthalmic assessment: Without Glasses With Glasses

Acuity of vision L ………………………… L ………………………
R ………………………… R ………………………
Colour vision L ………………………… L ………………………
R ………………………… R ………………………
Investigations:
Urine: Albumin ………………… Sugar ………………………… M/E ……………………

Chest X-Ray PA ………………………………………………………………………………………

Names and signatures:

Physician ………………………………… Gynecologist ………………………………….

Surgeon ………………………………….. Radiologist ……………………………………

Pathologist ………………………………… Ophthalmologist ………………………………

Chairperson Medical Board …………………………………………

Check list: Cross out (X), those not present and tick ( ) those present
History of
1. Prolonged fever 11. Previous operations or accidents
2. Cough/prolonged expectoration 12. Previous hospitalization & reasons
3. Chest pain 13. Allergies
4. Hemoptysis (Blood in cough) 14.Unconsiousness -focal or general seizures
5. Jaundice 15. Hypertension
6. Breathlessness 16. Tuberculosis
7. Swelling over body 17. Heart disease
8. Blood in vomit or stools 18. Diabetes.
9. Unusually irregular periods 19. Bronchial asthma / COPD
10. Mental illness 20. Skin eruptions
Any others, not included in this list …………………………………………………………..
Family history:
Diabetes ………………………… Hypertension …………………………
Tuberculosis ………………………… Heart Disease …………………………
Any other (specify) …………………

MEDICAL FITNESS CERTIFICATE FOR GOVERNMENT SERVICES

I do hereby certify that the members of the Medical Board of Sanjay Gandhi Postgraduate Institute of
Medical Sciences, have examined to Sri/Smt/Km ……………………………………………... as a
candidate for employment/training/confirmation in the Department of
………………………………………… as ……………………………………… and have not discovered
that he /she has any disease communicable or otherwise, constitutional weakness or bodily infirmity
except …………………………
Name or nature of illness / infirmity / disability:

I consider the person FIT / UNFIT for employment/confirmation in the Department of

…………………… as ………………………… . The candidate’s age according to his/her statement is
………… years and by appearance is …………… years.

(Signature of candidate) Chairman, Medical Board

Attested by:

Date ……………………
 Sanjay Gandhi Postgraduate Institute of Medical Sciences
Raebareli Road
Lucknow 226014, India
Phone: +91 522 2495511

Joining Report (To be filled in Duplicate)

With reference to appointment/admission letter no. PGI/ER/ACAD/………………………/20….……… dated

….…….……………………, I accept the terms & conditions of offer and join as a Senior / Junior Resident (MD/HS /
PDCC / DM / MCh) in………….………..………………. Department in Forenoon/ Afternoon of
……………………..…along with the following self-certified documents:
To be filled by office
No. Document Yes No NA
1. Certificate of age proof.
2. MBBS degree
3. MBBS Marksheet
4. Internship completion certificate
5. Proof of registration of MBBS degree with MCI or state medical council
6. Certificate of fitness from the Medical Board of the Institute
7. Fee deposit Receipt: No…………….….. Date……..……..Rs………………
9. Character certificates from two persons
10. Marital certificate
11. Declaration of dependents
12. Identification proof (PAN card, driving licence, aadhar card or passport)
13. Original admit card of entrance examination
14. Six passport size photographs
15. Hostel allotment form
16. Caste certificate, if applicable
17. Original NOC from previous employer, if previously employed
18. Relieving certificate from the last employer
19. Migration certificate(original, no. …………… (for MD/DM/MCh/PDCC/
PDF)

He/she should report for duty to Head of the Department immediately on ___________________ (FN / AN).
Name:-
Designation:-
Department:-
Signature of the student with date (Signature of HOD with date)

(Executive Registrar)

After HOD’s signatures, the form will be returned to the Academic Section.
Copy to following for information and necessary action:
1. Provost SGPGI (To report with the hostel allotment forms)
2. Personal file
 ANNEXURE 7
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow
Application for Hostel Accommodation
1. Name: Age: Gender:
2. Department Affix recent
3. Designation Photo (passport
size) duly
4. Marital status attested by HOD
(Signature with seal)
5. Date of joining
6. Duration of course/project
7. Date of tenure end
8. Complete permanent address with telephone nos

9. Complete address of local guardian with telephone no

10. Name of person(s) to be contacted in emergency, with telephone no.:

11. Own mobile number and land line no.

12. Email ID

I, ………………………………………., undertake to abide by the hostel rules and any

instructions given by warden/ provost.

Applicant’s signature HOD’s signature and seal

(Remarks of Provost)
 Annexure 8
Phone: (0522) 2494011, 2494537, 2494304, 2495285,5266

Sanjay Gandhi Postgraduate Institute of Medical Sciences

Lucknow 226014

CERTIFICATE
(TO BE SUBMITTED IN DUPLICATE)

This is to certify that the following documents of Dr.

………………………………………… S/o, W/o, D/o …………………………………………
have been received by the Institute in original as he/she has decided to pursue
MD/DM/M.Ch course in ………………………… specialty at this institute for the session
commencing from October, 2022 and these certificates will only be returned to the
student after completion of two years mandatory service bond of UP Govt. on
submission of certificate to this effect.
1. High School/Date of Birth certificate
2. M.B.B.S. Degree
3. MBBS Marksheets (1-4 years)
4. MBBS Medical Registration
5. Internship Completion
6. Caste Certificate (if applicable)

Signature of Candidate
Executive Registrar

UNDERTAKING
(TO BE SUBMITTED IN DUPLICATE)

I, Dr. …………………………………………. understand that my original certificates will

be retained by the Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGI),
Lucknow and these will not be returned before completion of MD/DM/M.Ch in the
specialty of …………………………………………, unless I, Dr.
……………………………………… pay to the SGPGI, Lucknow a sum of Rs. 5,00,000
(Rs. Five Lac only) irrespective of the fact whether I continue the course or not.

Roll No. …………………………………………

Permanent Address: …………………………..
……………………………………………………
……………………………………………………
……………………………………………………
………………………………………

Signature of candidate
 Annexure 8
Phone: (0522) 2494011, 2494537, 2494304, 2495285,5266

Sanjay Gandhi Postgraduate Institute of Medical Sciences

Lucknow 226014

CERTIFICATE
(TO BE SUBMITTED IN DUPLICATE)

This is to certify that the following documents of Dr.

………………………………………… S/o, W/o, D/o …………………………………………
have been received by the Institute in original as he/she has decided to pursue
MD/DM/M.Ch course in ………………………… specialty at this institute for the session
commencing from October, 2022 and these certificates will only be returned to the
student after completion of two years mandatory service bond of UP Govt. on
submission of certificate to this effect.
1. High School/Date of Birth certificate
2. M.B.B.S. Degree
3. MBBS Marksheets (1-4 years)
4. MBBS Medical Registration
5. Internship Completion
6. Caste Certificate (if applicable)

Signature of Candidate
Executive Registrar

UNDERTAKING
(TO BE SUBMITTED IN DUPLICATE)

I, Dr. …………………………………………. understand that my original certificates will

be retained by the Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGI),
Lucknow and these will not be returned before completion of MD/DM/M.Ch in the
specialty of …………………………………………, unless I, Dr.
……………………………………… pay to the SGPGI, Lucknow a sum of Rs. 5,00,000
(Rs. Five Lac only) irrespective of the fact whether I continue the course or not.

Roll No. …………………………………………

Permanent Address: …………………………..
……………………………………………………
……………………………………………………
……………………………………………………
………………………………………

Signature of candidate
 Annexure 9
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow
Application for Declaration of Dependents for staff and dependents registration

Date of Joining: …………………………………

Employee ID

Details of Employee
Name DOB Sex Department Designation Telephone Bank A/c no. Old/new CR No.
First Name Middle Name Last Name (DD/MM/YY) (M/F) no.

Details of Dependents
S. Name Age/ DOB Relation with Profession if employed Whether medical Basic pension Total Old/new CR
No (DD/MM/YY) employee or name & address of facility provided by per month income from no.
and sex (M/F) department, if retired. employer w.e.f. 1/1/96 all sources

I hereby certify that the above mentioned family members are fully dependent upon me as per above mentioned details. I also certify that the entries in the form have
been made by me are correct. I hereby give the undertaking that if any of the entries in the form are found to be incorrect of false at any time I shall be fully responsible
for the same and suitable disciplinary action may be taken against me including recovery of amount spent on treatment of any of my dependent.

Signature of Employee
Annexure 11
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow
Registration Form for E-mail and Hospital Information System (HIS)
Section 1: Application
Name Date
Designation Valid till
Department Phone (Off)
Preferred Username Phone (Res)
(max. 8 alphabets, all lowercase)
Date of Birth Employee ID

I undertake to use the Hospital Information System only for my assigned official duties and to maintain the
confidentiality of the patient data in the system. I shall keep my password secret and shall be responsible for all
activities performed using my username and password.

Applicant’s Signature

IMPORTANT INFORMATION FOR ALL APPLICANTS

Please note that for every activity on the HIS, the computer records the username and password of the person
performing it. Your password is like your electronic signature. You are therefore advised to change your initial
password immediately after it is assigned to you and frequently thereafter. You MUST NOT reveal your password to
anyone at any time. In case you suspect that someone may have come to know your password, change it immediately.
The password should preferably be 6-10 characters long and consist of a mixture of alphabetical and numeric
characters. You are advised not to use your name, initials, date of birth, family members’ names, etc. as password since
these can be easily guessed. If you have any queries or have forgotten your password, please contact the system
administrator.
Section 2: Authorization
[ ] HIS Facility [ ] E-mail facility
Functions/areas in various Modules etc.
[ ] Billing Nodal [ ] Resident
[ ] Billing Clerk [ ] Consultant
[ ] HRF Clerk [ ] Lab Technician
[ ] HRF Nodal/Supervisor [ ] Nursing Staff
[ ] HRF Unit [ ] Hospital Administration
[ ] HRF Misc [ ] Stationary
[ ] OPD/Bay Clerk [ ] OT Staff
[ ] Registration Clerk/Supervisor/PRO [ ] CSSD/Dietary Staff

HOD

Section 3: Username assignment

Username assigned (HIS) Logon name for E-mail

I have understood the method to change my password and have changed my originally assigned password.

Applicant’s Signature

System Administrator’s Signature

 Annexure 12
Proforma for Identity Card
(Must be filled in Block letters)
MIU
SGPGIMS
Date of Joining……………………..
Term upto:…………………………..

Employee ID No. Card No.

(for office use only)
Valid from to
Name
Designation Pay Scale*
Department Intercom No.
Blood Group Previous Card No.
(in case of loss)
Photo
Permanent Address & 35 mm X 45 mm
Telephone No.

Name & Address of the

Person to be intimated
In case of emergency/Local Address &
Telephone No.

Signature of Applicant Recommendation by HOD

Verification by

Establishment Establishment Academic Section

(Main Administration) (Hospital Administration) (Executive Registrar Office/SRO)
 Annexure 13
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow
Application Format for Activation of Wi-Fi Connection
(Senior Residents/Students residing in MRA and Hostel areas)

Name of Resident:_______________________________ Employee ID:__________________

Course (DM/MCh/SR-HS/MD/PhD):__________ Date of admission:_____________ Valid till:_______
Designation:_____________________________Department:_____________________________
Qtr Type:___________ Qtr No:________Location:___________________________________
Mobile/CUG No:_______________________Phone No (Res):___________ (Off):______________

Details of computer, laptop, mobile etc in which Wi-Fi network will be used:
Sl Type of Make Wi-Fi MAC address of equipment
no equipment

I undertake that:
1. Above devices will be used by me for research and academic purposes.

2. Any misuse of the connectivity through these devices will be my sole responsibility.

3. In the event of theft/loss of any device, I will immediately inform data centre for blocking the
device.

Date: (Signature of applicant)

Signature of Provost (Signature of HOD)

Note: Please attach copy of house allotment letter

 (On 100/- Rs. Stamp Paper)
Course Bond

SANJAY GANDHI POST- GRADUATE INSTITUTE OF MEDICAL SCIENCES,

LUCKNOW –226014
BOND FOR THE CANDIDATE ADMITTED TO MD COURSE (JUNIOR RESIDENT) AT
SGPGIMS

Known all men by these present that we, Dr. ………………

……………………………………S/o,D/o………………………………………………...……..R/o
…………….…………….……………………………. at present a selected candidate of
……………………………………at Sanjay Gandhi Post-Graduate Institute of Medical
Sciences Lucknow-226014 (hereinafter called the Junior Resident) and
Shri/Dr.……………… ………………………….. …………… S/o, D/o
…………………………………R/o ……………………………… (hereinafter called the surety),
do hereby jointly and severally bind ourselves (and shall include our respective heirs,
executors, administrators etc.) to pay the Director Sanjay Gandhi Postgraduate Institute of
Medical Sciences Lucknow-226014 (hereinafter called the SGPGIMS) on demand without
any demur, claim, proceedings the sum not exceeding Rs. Five Lac within a Period of two
weeks from the date of such demand.
WHEREAS the above named Dr. .………………………………has been selected in
the discipline/ Department of ………………………...for admission to MD/MS course and
appointment against the post of Junior Resident for a period of three years, commencing
from May, 2021.
WHEREAS the above named Junior Resident has undertaken to join the above
post/course on the conditions that he/she shall not leave the post and course in between
the mid-term of the entire session of the three years.
AND WHEREAS the above named Junior Resident has also undertaken that if
he/she resigns or leaves the course/post , he/she shall be liable to pay a sum of
Rs.5,00,000/- (Rupees five lac only) as damages/compensation/penalty to the Institute.
AND WHEREAS the liability under the above bond shall be binding and effective for
full term of the course from the commencement of the session and shall be enforceable for
any liability arising thereafter subject to the following clause.
 PROVIDED that on request of the Junior Residents and/or surety if the
SGPGIMS, extends the time for making payment of the above noted sum of Rs.
5,00,000/- or five Lac as the case may be this bond shall remain effective and in force
till such payment is made However, the bond executed by the Junior Resident and the
surety shall remain effective, binding and enforceable till the time of decision of
SGPGIMS not to enforce the same by order of the competent authority.

PROVIDED always that the liability of the surety herein shall not be
discharged/impaired by reason of the time being granted or by any other act or by any
forbearance act of the SGPGIMS or any person authorized by them, whether or without
the consent or knowledge of the surety, nor shall it be necessary for the SGPGIMS to
sue the said Junior Resident before suing the above named surety Shri
……………….……………………… for the amount or part of the amount due
hereunder:-

The decision of the Director, SGPGIMS shall be final on any dispute that may
arise. All disputes shall be subject to Lucknow Jurisdiction.

SIGNED, EXECUTED AND DELIVERED ON THIS DATE …………………… IN

THE PRESENCE OF FOLLOWING WITNESSES.

WITNESS:-

1.
JUNIOR RESIDENT

2.
SURETY

EXECUTIVE REGISTRAR DEAN

 (Service Bond)

AGREEMENT BOND FOR CANDIDATES ADMITTED TO

-------------------------COURSE-----------------------------SESSION
THIS DEED OF AGREEMENT BOND IS EXECUTED AT ----------------------ON THIS DAY
OF---------------------------------

BETWEEN
NAME----------------------------------------------------------------------------------------------------
S/O, D/O,W/O-------------------------------------------------------------------------------------------
RESIDING AT (PERMANENT ADDRESS)-------------------------------------------------------
(TEMPORARY ADDRESS)--------------------------------------------------------------------------
MOBILE NO.--------------------------------------------------------------------------------------------
E-Mail ID:------------------------------------------------------------------------------------------------
AADHAR No.-------------------------------------------------------------------------------------------
Hereinafter referred to as (“FIRST PARTY”) of the one part
AND
Governor of Uttar Pradesh (here in after referred to as “Government”) of the Second Part.
WHEREAS FIRST PARTY has applied for admission to--------------------------course and FIRST
PARTY has been selected to the said course. As per the Prospectus, the FIRST PARTY has
agreed to serve the Government for a period not less than two year after successful completion
of the --------------- course.
If the FIRST PARTY fails to serve the government for a period of two year the FIRST PARTY
shall forthwith pay a sum of Rs. 40 Lacs for Degree and 20 Lacs for Diploma, MDS to
Government at the specified Government Treasury. During the above period the FIRST
PARTY shall be paid Stipend and the Government will request their services within a period of
three months from the date of successful completion of the -------------- course. In case the
Government does not provide services in mentioned period, the BOND shall be released : AND
WHEREAS the FIRST PARTY has also agreed that on successful completion of the -------
course his/her certificates relating to ------- course will not be given to the FIRST PARTY
unless the FIRST PARTY successfully Serves the Government for a period of two year or pay
to the Government on Demand the sum of Rs.-------- ( Rupees ----------------------------------)
only.
If the FIRST PARTY fails to deposit the aforesaid amount in specified period, FIRST PARTY
shall be liable to pay interest at the rates specified by the Government as per applicable law
during the period of delay; AND WHEREAS the Government have, at the request of the FIRST
PARTY ------------------- employed as --------------- granted stipend to him/her for a period of 24
months effect from --------------- in order to enable his/her to study at -------------------------------
College .
AND WHERE AS if the FIRST PARTY -----------------------------------------------------------------
work as for a period of less than 24 months during the -------------------------------- Super
specialty course DM/MCH/ ---------------- Post Graduate Degree
MD/MS/Diploma/MDS/Graduate Degree MBBS/BDS course, the proportionate amount will be
treated as stipend and the FIRST PARTY ---------------------------- shall pay back in addition to
the security amount of stipend to the Government. This bond shall in all respects be governed by
the Laws of India, for the time being in force, and the rights and liabilities shall, where
necessary, be accordingly determined by the appropriate courts in India.

Now THIS DEED OF AGREEMENT BOND WITNESSES BOND WITNESSES AS

FOLLOWS:-
1. The FIRST PARTY has agreed to serve the Government for a period of two year on
successful completion of the ------------------- Super specialty course DM/MCH/Post
Graduate Degree MD/MS/Diploma/MDS/Graduate Degree MBBS/BDS course. If the
 FIRST PARTY fails to serve the Government for a period of two year, FIRST PARTY
shall pay forthwith a sum of Rs. --------------------------- ( Rupees ---------------------------
only) to the Government in the specified Government Treasury.
2. The FIRST PARTY Agrees that till the successful completion of the period of two year
service to the Government or till the payment of Rs. -------------------( Rupees -------------
-----------------) only is paid the certificates relating to ----------------- Super specialty
course DM/MCH/ ---------------------- Post Degree MD/MS/Diploma/MDS/Graduate
Degree MBBS/BDS course shall be in the Custody of the Concerned Institution /
University/ College and the Government has a First lien over all the certificates gained
by the candidates at the time of admission.
3. The FIRST PARTY authorizes the Concerned Institution / University/College for
retention of the certificates till the lien of Government is cleared/discharged.
4. The BOND shall in all respect be governed by the Laws of India, for the time being in
force, and the rights and liabilities shall. Where necessary, be accordingly determined by
the appropriate course in India.
5. If the FIRST PARTY fails to deposit the aforesaid amount in specified period, FIRST
PARTY shall be liable to pay interest at the rate specified by the Government as per
applicable law during the period of delay, failing which Government shall have right to
recover the aforesaid amount together with interest as arrear of land revenue.
6. The FIRST PARTY shall borne the Stamp duty chargeable on this BOND IN WITNESS
WHEREOF parties to this Deed have signed this BOND on the date first above
mentioned.

For and behalf of For and behalf of

FIRST PARTY Governor
( ) ( )