Scribd
Upload
62 views

Appform Amc

This document is an application form for entry into the Indian Armed Forces Medical Services through short service commission. Only Indian nationals are eligible to apply. The form requests personal details such as name, date of birth, education qualifications including medical degree and internship details. Applicants must enclose relevant documents like registration certificates and a demand draft for Rs. 200 with their application. The last date for receipt of completed applications is May 16, 2011.

Uploaded by

Phanindra Kazipeta
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
62 views

Appform Amc

This document is an application form for entry into the Indian Armed Forces Medical Services through short service commission. Only Indian nationals are eligible to apply. The form requests personal details such as name, date of birth, education qualifications including medical degree and internship details. Applicants must enclose relevant documents like registration certificates and a demand draft for Rs. 200 with their application. The last date for receipt of completed applications is May 16, 2011.

Uploaded by

Phanindra Kazipeta
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

ARMED FORCES MEDICAL SERVICES

APPLICATION FORM FOR SHORT SERVICE COMMISSION ENTRY MAR 2011


(ONLY INDIAN NATIONAL ARE ELIGIBLE TO APPLY)

Space for pasting recent colour


passport size Photograph

IMPORTANT INSTRUCTIONS FOR COMPLIANCE Do not staple the photo


Please cut photograph to fit in
• Write NEATLY in CAPITAL LETTERS ONLY this box
• Write with black ball pen in the squares. PHOTO NOT TO BE
• Do not pin/ staple the photograph. Cut the Photograph to the size of the BOX. ATTESTED
• Fill up all the columns. If not applicable write ‘NOT APPLICABLE’
• Do not leave any column blank
1(a) NAME OF APPLICANT (Give one box gap between First/ Maiden/ Surname) (As per Matriculation Certificate)

(b) NAME OF APPLICANT IN HINDI ___________________________________________________________________

(c) Have you ever changed your name (after matriculation) : Yes/No

(d) If Yes:-

(i) New Name of Applicant (Give one box gap between First/Maiden/Surname)
(As per Central/State Gazette Notification/any other authority)

(ii) New Name in Hindi:-


(Enclose photocopy of Gazette Notification or any other authority clearly highlighting your new name)

2. NAME OF FATHER (Give one Box gap between First / Middle / Surname)

3. NATIONALITY OF SELF AND SPOUSE


(a) Self: (b) Nationality of Spouse:
(c) Date of Marriage: (d) Date of acquiring Indian citizenship(if foreigner):
4. DATE OF BIRTH: 5. SEX: Write Code ‘M’ for Male
‘F’ for Female

DATE MONTH YEAR

6. AGE AS ON 7. Details of previous AMC Service, if any:


31 DEC 2011 Short Service Commission (SSC)
Date of Commission :
Date of release :
YEARS MONTHS DAYS (Copy of release order to be enclosed)
Note: Candidates already released after completion of 10 years of SSC service, on
resignation/PMR from AMC service need not apply.

8. Demand Draft No _________________ Dated __________________ Payable Bank


________________________
___
9. Postal Address for Communication (with State & 10. Permanent Address (with State & Pin Code in Block
Pin Code in Block CAPITAL Letters only): CAPITAL Letters only):
___________________________________________ ___________________________________________
___________________________________________ ___________________________________________
___________________________________________ ___________________________________________
Tel ________________ PIN Tel ________________ PIN

11. DETAILS OF SPOUSE (if married) :


(a) NAME (b) OCCUPATION (c) Whether he/she has also applied for grant of SSC in AMC
(State yes or No)
12. NAME OF MEDICAL COLLEGE AND UNIVERSITY FROM WHICH MBBS DEGREE OBTAINED AND YEAR:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
13. Date of Admission to Medical 14. Date of Passing M.B.B.S: 15. No of attempts taken to pass the final
College: MBBS examination:

(Enclose Attempt Certificate)


(Application of Candidates who have
DATE MONTH YEAR DATE MONTH YEAR taken more than two attempts will be
REJECTED)

16. Date of Completion of Internship Training: 17. Whether the Medical College from where you have passed
MBBS is recognized by MCI:

DATE MONTH YEAR Write ‘Y’ for Yes


‘N’ for NO

18. PG Qualification, if any, give details with date:


Degree ________Subject _____________________ College / University__________________________

Year

(State whether the College/University is recognized by MCI / or not) Write ‘Y’ for Yes, ‘N’ for No

19. Permanent Medical Registration Certificate number and issuing office:


_______________________________________________________________________________________

20. If employed give particulars of present employment and 21. Details of NCC Training (Indicate A, B, C Certificate
attach ‘No Objection Certificate’: passed):_________________________
__________________________________________
22. Hobbies: _______________________________________

DECLARATION

I hereby solemnly declare that all the statements made by me in the application are true and correct to the best
of my knowledge and belief. At any stage, if information furnished by me is found to be false or incorrect I will be
liable for disciplinary action or termination of service as deemed fit.

Station : (Signature of the Candidate)


Date :

IMPORTANT NOTE FOR STRICT COMPLIANCE: 1. Incomplete application not on format and without requisite enclosures
will be summarily rejected. 2. The allotment of Service depends on availability of vacancies and service exigencies. 3. The
following documents should be essentially enclosed (only attested copies required) (i) Matriculation Certificate and age proof
certificate (ii) Permanent Medical Registration Certificate & Internship Completion Certificate (iii) MBBS / PG Examination
Degree / Certificate (iv) Final MBBS attempt certificate (v) No Objection Certificate from present employer, if any. (4) One
Self addressed envelope without postage stamps (postal address and name of the candidate be written in capital letters on
the envelope) (5) Alongwith application a Demand Draft for Rs 200/- in favour of DGAFMS (APF) payable at New Delhi will
be enclosed. Candidates should write his/her particulars on the backside of demand draft (6) All documents should be
properly tagged with the application. (7) More than one application in a single envelope will result in rejection of all such
applications. (8) Applications of candidates who send more than one application will also be rejected.

LAST DATE FOR RECEIPT OF APPLICATION: 16 May 2011.


OTHER DETAILS ARE ALSO AVAILABLE ON WEBSITE: www. indianarmy.gov.in
ADDRESS: DGAFMS / DG-1A, Ministry of Defence, ‘M’ Block, Room No.60, Church Road, New Delhi – 110001

You might also like