Ajmer. Subject: - Reporting for admission in First MBBS-Batch 2020. Sir, einige icanie been allotted MBBS Course 2020 in your Institution in the 1*/ 2" ‘extended! Ope! Mop round af ceuling tough All India Quota/Rajestan State QuotaNRI though NEET-2020/Cental Pool Therefore I am reporting today ie, on ____at JLN Medieal Colless, Ajmer. Kindly accept my reporting forthe 1% M,B.B.S. Course (Batch 2020). 1 amt submitting the following original documents:- SN. | Documents (as per applicability) Y/No Remarks 1 [Allotment letter 2 | Score Card (NEET-2020) 3__| Admit Card (NEET-2020) 4 | Rank Letter (NEET-2020) 5__| Registration Form for Rajasthan State Medical Councelling-2020 6 | Receipt issued by eMitra/CSC kiosk containing the Token Number 7 8 9 Certificate of eligibility Criteria (Domicile/Bonafide/Other) ‘Senior Secondary School Mark-Sheet ‘Senior Secondary School Passing Certificate 10 | Secondary School Mark Sheet I1__| Secondary School Passing Certificate 12 | Mark sheets of VIMI, IX, XI 13_ [Transfer Certificate from School Last Attended 14 | Migration Certificate of the Board/University Last aitended/enroled 15__| Character Certificate from School Last Attended 16 _ | Copy of Photo ID/Aadhar Card (JO, 17 __| Four Recent Passport size photographs, 18 | Undertaking /Service Bond/ Surcty Bond Rs. 5.00 lacs (on Rs 500/- stamp paper) 19 | Caste Certificate (ST/SCIOBC/MBC-NCL) 20 | Documents/Certificate related to SAB/SAG 21 | Documents/Certificate related to EWS 22 | Documents/Certificate related to NRI {Proforma 6 or 7 (undertaking issued on or after 5.5.19) and Proforma 8} 23__| Disability Certificate - ifapplicable 24 Defence forms & certificate(s) pertaining to pre-filled EXS1/ EXS2/ EXS3/ EXS4/WPP (if applicable) 25 _| Relieving Letter (if any) 26 _ | Medical Fitness Certificate i 27 | eraw-a (wtereff } 1 Anti Ragging, 2. Original documents rua (afta / vere): Anti Ragging 28 | Parents’ Income Certificate 29 | Photo copy Set_of Documents (S.No. 02 to 14, 181021, 23.28 & 31) 30__| Gap Certificate 31__ | Compulsory Covid Test | Yes/No Positive/Negative date of Test Alll above documents verified All above documents deposited ....sssessssesve Cashier to deposit fees as per rules . Allentry has been made online ..... Signature of Candidate NEET-20 Role No. «... Name:, Date: 72020PA VUE Jate of Birth — ‘Age on (31-12-2020. ‘Occupation of Father. Feainet’s Name... “Marks ofthe identification of the studert..... 1. PHYSICIAN'S REPORT : A. General Medicine 3, THY IST'S RE i Mision; Height ean Without spects : Rl. eye Weight. Lteye. Chest In-expiration ..... ms. With spects: Rteye Insinspiration cms. Lteye BP. tnantcn retinal MONO, Colour Vision: Heart ae Trachoma: . Lungs Spleen. ca 4, ENT. SPECIALIST'S Liver: Hearing Ri ear \ Neurologist. Lear... ‘Skin Diseases Tonsil... Any other: . ‘Any Other 8. IMMUNE : T.AB/ Cholera vaccination ar When Taken. 5. GYNAECOLOGIST’S REPORT : MontouxTest, Yes/No (For Gir's candidate only) C. PATHOLOGISTS REP D. : 2. SURGEON'S REPORT : Harnia: Hydrococele Piles / Fistula: SIGNATURE OF CHAIRMAN... a ‘Abdomen GENERAL REMARKS FIT/UNEIT Limbs Deformations SIGNATURE OF MEMBE! ‘Any othre abnormalities Signature of student with permanent address, phone no, and'mobile no.EEKSUNAL INKUKMATION / CHECK-LisT ‘COURSE: M.B.BS.(BATCH - 2020) AlUInut than State ota INRV Central Pool (nominees To be filled by the Candidate General Remarks Full Name (Candidate) Full Name (Father) Full Name (Mother) Gender Male/Female (Other Recent Photograph Religion & Caste Address Local Pincode: Ig. Address Permanent Mobile No. Student ; i Ethers. Mothers li, Email Address Student Father: qj. ‘Occupation 1k. “| Annual Income [2 | Rank All Ini Ra Stare Rank: Category Rank: a. Roll No. (NEET-2020) core / Pereentl perce eae § ae MEET (2020) Sore: Sa Seo ‘sShpecenic ener) NEET (2020) Percent eects SS 00 3 | bateoisiah ay ae ton enor Bae 32003 (eee scr (OD/MM TYYYY) aca ae eS 6. lens Max. Marks | ~~ Marks Obtained —[Pevaompe) (Total) (Total) = Secondary School Exams ‘Marks (Sr. Secondary Subject Max. | Marks Pass] Weis o RE aay ra School Exams) Marks | Obtained | Fait sthave passed in the ; Toad Mie technolory 8 Physis Chemisty fox te Sest/oscrae Pay Es English ; Ta [ss —~ [Main subjects [Passing ear [Fusing Scar TASETOROGTSe | Css a Gass | Cass vil :Class V Cssv Cassi Class I Class | l i (Furthermore, study of 7b | Studied Biology as YeriNp biology/bio-technology as additional subject? ‘an additional subject at 10+2 leve, also shall not permissible.) = ar and continuous Hadyoy (i sas ay | BENT PRETO Prt anno School as Regular/ Private/ Faken together shall be required at 10+2 jets Open School? _ the candidates. Passed 1042 from hols or as a private candidate shall not le) 3 8. | Certificate oF ligibility | (Domicile? Bonalide/ Other Criteria, Au % Ba [state of hesidenca? Rajasthan Omer Onan om Sate of K and TABART re . Site nana’ JOT ELIGIBLE. if they claim eligibility, they mus (mention Other ‘Spite nated ibmit online Self Declaration as Appendix 111.) 9 | Documents elated To NET Proforma 6/7 and Proforme & 93° Defence forms & cerinons YEO Pérsining to pre-led EXSI 7EXSS7 Certificate EXS4 / wpp. (Gf applicable) 10 State Quota: Enclosed/ Not Enclosed Duly filled Registration Form 10a. Receipt issued by Amount deposited Rs, tra/ CSC kiosk containing L_fre Token Numa! Recall q ‘hat above given Information is 1 do hereby ce; ue and best to my knowledge @ bal Signature of Candidate Officer-in-Charge (Academie) Receix/D.0 Nose 200 aac /2020 Amount Rs h Signature of CashierBOND / UNDERTAKING resident at conse (here after called surety ) do hereby » and severally bind ourselves and our respective heirs in execution and administration to ‘he Govt. of Rajasthan (herein after called the Government) on demand the sum of ‘s8,000/- (Rupees Five lacs only) together with interest thereon from the date of demand ovt rates for the time being in force on Government loans, AND TOGETHER with all costs sven attomey and client and all charges and expenses that shall or may have been incurred by oovermment, - ‘That in consideration of the Government of Rajasthan, selecting vide Allotment letter / an. se Date .«- the MBBS course in during the academic ., the MBBS student and his surety covenant with the Government as follows: - 1- Candidates who are selecting Government seats for the MBBS course shall not resign the course before the completion; Candidates who are selecting Government seats for the MBBS course shall serve the Government for a minimum period of wo years after completion of the course, if 2 Government so desires; 3 That in case the MBBS students, who fails to fulfill the above conditions, the surety of the MBBS students shall be jointly and separately liable for penalty of Rs.5,00,000/ as per this Bond / Undestaking. witness whereof the Obligor and the surety above mentioned have here unto set their hands clay and the year first above written, Sy Signature of the MBBS student Vitness:~ Signature, Name & Address of the Surety lL ofPROFORMA - 10 Wl candidates who have been all Undertaking T » age years, S/0,D/o ___—_—_____ hereby undertake that: 1. Thave got allotment for admission on MBBS/BDS course in the college eee ee rotons tab ae For admission, I have deposited my documents in original, as required. All the documents are in original and are not forged/photo copy/printed copy. If any document is not found original or is found forged / photocopy / printed copy, I will be responsible for cancellation of my admission and other action as may be taken by the appropriate authority. _—__ Signature of the candidate ee een) Signature of the Father / Mother /Guardian i the age of 18, (Note: If the student is below this undertaking shall also be rs Oe father/mother/guardian of the candidate).