All India Institute of Medical Sciences (AIIMS) Bhubaneswar

(A statutory body under the aegis of Ministry of Health and Family Welfare, GOI)
Sijua, Post: Dumuduma, Bhubaneswar (Odisha) - 751 019
Web site: www.aiimsbhubaneswar.nic.in

No. AIIMS/BBSiDEAN/ADMISSION/1/ DATE: lll02/2022

$jO,
INS'I'R[]CTION I.-OII CANDID.{I'E,S SEEKING ADNIISSION AT AIINIS, BHTIB.{NESWAR
'l'he Director. faculty and staff congratulate
1'ou on obtaining admission in All India Institute of Medical Sciences (AIIMS).
Bhubanesr.r,ar. It rvill be our endeavour to ensure that. 1'our transition fiom to AIIMS, Bhubanesrvar is hassle free. You are advised
to read the tbllor'r,ing instructions carefully' befbre ,^'dmission.

Programme for Admission Process of B.Sc.(Hons) Paramedical' Batch 2021

Officials Date, Time and Venue
r Dr. Gaurav Chhabra, Faculty In charge (Paramedical) . Date : I't (lounselling ( I l1h February 2022x to 14fr
r Mr. B. B. Mishra, Registrar Febnrary'.2022).
r Mr. B. R. Parida, PPS
o Mr. B. B. Das, JAO 2'd Counsclling ( l8'h February 2022 tt:t

2310212022)

o Time : l0:30 A.M. to 05:00 P.M. (Monday to Friday)

10:00 A.M. to 0l:30 PM (On Saturday)
o Venue : Academic Section
*The admission will remain closed on l3-02-2022(Sunday),QXO-O>2922-C,3*"C.Y).

MANDATORY REOUIREMENT OF DOCUMENTS (IN ORIGINAL) DURING ADMISSION

l. Laboratory Tests: Reports of X-Ra1 chest (PA vicu') Random Blood Sugar. Urinc Analy'sis. Blood Group and Rh
lactor to be done trom a Government/ NABL accredited laborator) Lry the student trefore reporting the Institute.
2. Rank letter.
3. Provisional Allotment Letter tiom AIIMS. Neu' Ilcllri.
1. Original Bank Draft worth Rs. 5000/- (Five thousancl onl1,) in l-avour of AIIMS, Bhubaneswar Academic Fund (A/c
No. 557810110001482). (Please rvrite )'our Name. Mobile No.. All lndia Rank and e-mail ID (IN CAPITAL LETTERS) at
the reversc of the Bank Draft.)
5. Date of birth Certificate OR celtillcatc fiom the board fiom rvhich you passed the high school / higher secondarl'
examination shorving date o1' birth.
6. Certificate of having passed the l0+2 examination shorving the subjects in the examination.
7. Mark sheet of I 0+2 exam ination liorn the Board fiom u,hich 1ou passed the same.
8. Migration certificate fiom the LJnivcrsitl' / Board last attended b1 you.
9. Caste Certificate shou'ing that the student bclong to Schcdulc Caste/ Schcduled Tribe/ OBC (NCl.y EWS categorl
(Applicable onl1, if thcl' have claimed in their application that they belong to that catcgor.v) as per the presclibcd fblmat
issued by the Government of India. The validit;- of OBC certiflcates must be issued during 1510612020 to 2811212021
(both dates inclusive) and sinrilarll the validity ol'L,WS celtiflcates must be issued during 0110412021 to 28/1212021 (both
dates inclusive).
10. PwD Certificate if applicable as mentioned in the prospectus.
I I . 2 (two) sets of photocopies of the above documents (self--attested).
12. Current Passport size photograph (ll'ont lacing) 5 copies.
13. CANDIDATE INFORMATION SHEET: (appendix-A)
14. AFFIDAVIT FOR PARENT / GUARDIAN on non-judicial stamp paper rvorth Rs. 10.00: (Appendix-B)
15. AFFIDAVITBYTHESTUDENT:onnon-.iudicial stamppaperr.r,olthRs.l0.00 (Appendix-C)
16. DECLARATION BY THE CANDIDATE (Appendix-D)
17. UNDERTAKING BY THE CANDIDATE (Appendix-E)

HOSTEL: It is mandatory for students to siay in thc hostel during the tenure of the course. Students should arrange the items like
rvater.jug. tumbler. plastic bucket. Mug. Pillou,. Bed Shccts. Tw,o locks to ensure a comfbrtable stav.

IMPORTANT: Please note the Institute shall not reimburse any expenditure incurred by any student because of travel and
maintenance in connection with their.ioining the Institute.

The tentative date of commencement of classes will be 2810212022-

AIIMS, Bhubaneswar
 APPENDIX - A
All India Institute of Medical (AIIMS) Bhubaneswar
Sciences
Sijua, Post :Dumuduma, Bhubaneswar (Odisha) - 751 019

CANDIDATE INFORMATION SHEET

PLEASE FILL UP THE FORM IN CAPITAL LETTER ONLY

In CAPITAL LETTERS with Prefix SHRI.

Father's Name

Mother's Name

Address for Correspondence :

House No.
STREET
ATiPO
Police Station
District
State
Pin code

Permanent Address:
House No.
STREET
AT/PO
Police Station
District
State
Pin code

Telephone Numbers (Mobile / Landline):

Mobile Landline
Candidate
Father
Mother
Email ID: In CAPITAL LETTERS

Parent Signature Student Signature

 APPENDIX - B
All India Institute of Medical Sciences (AIIMS) Bhubaneswar
(A statutory body under the aegis of Ministry of Health and Family Welfare, GOI)
Sijua, Post :Dumuduma, Bhubaneswar (Odisha) - 751 019
Web site: www.aiirmsbhuhaneswar.edu.in

AFFIDAVIT (For Parent / Guardian)

.(full name of parenUguardian),

Name)
father/mother/guardian of,(Student Regd
No.-havingbeenadmittedtohavereceivedacopyoftheUGC
Regulations on Curbing the Menace of Ragging in Higher Educational Institutions, 2009( hereinafter called the Regulations")
carefully read and fully understood the provisions contained in the said Regulations.

I have in particular perused clause 3 of the Regulations and am aware as to what constitutes ragging.

3 I have also, in particular, perused clause 7 and clause 9.'1 of the Regulations and am fully aware of the penal and
administrative action that is liable to be taken against my ward in case he/she is found guilty of or abetting ragging, actively
or passively, or being part of a conspiracy to promote ragging.

4. I hereby solemnly aver and undertake that:-

(a) My ward will not indulge in any behaviour or act that may be constituted as ragging under clause 3 of the
Regulations.
(b) My ward will not participate in or abet or propagate through any act of commission or omission that may
be constituted as ragging under clause 3 of the Regulations.

5. I hereby affirm that, if found guilty of ragging, my ward is liable for punishment according to clause 9.1 of the
regulations, without prejudice to any other criminal action that may be taken against my ward under any penal low or any law
for the time being in force.

6 I hereby declare that my ward has not been expelled or debarred from admission in any institution in the country on
account of being found guilty of abetting or being part of a conspiracy to promote, ragging and further affirm that in case the
declaration is found to be untrue, the adnrission of my ward is liable to be cancelled.

Declared this_dayof_month of__year.

Signature of deponent
Name:
Address:
Telephone / Mobile No.:
VERIFICATION

Verified that the contents of this affidavit are true to the best of my knowledge and no part of the affidavit is false
and nothing has been concealed or misstateci iherein.

Verified at (Place)_on this the (day) of (month)_(year) 20.

Signature of deponent

Solemnly affirmed and signed in my presence on this the. .(day) of_(month)20_(year)

OATH COMMISSIONER
 APPENDIX - C
AFFIDAVIT BY THE STUDENT
(on ro/- Non-Judicial stamp papers)

S/O,D/O ofMr. /M

Resident of

L. Do hereby solemnly affirm and declare as under:

2. That I am a citizen of India.
3. That I have completed L7 years of age on-/ will be completing 1,7 years
of age
4. That, I am joining as a student of MBBS/B.Sc[Nursing]/B.Sc(Honsl Paramedical at All India
Institute of Medical Sciences IAIIMSJ Bhubaneswar.
5. That I have gone through the contents and fully understood the AIIMS, Regulations/
Directives for Ragging and Anti-Ragging Measures in accordance with the AIIMS,
Bhubaneswar Office Order on curbing the menace of Ragging to be followed by all the
students of AIIMS.
6. I hereby solemnly affirm that:
o I will not indulge or involve myself in any untoward behaviour or act, that may come
under the definition of ragging.
r I will not participate in or abet or propagate ragging in an1' fsrr.
r I will not hurt anyone physically or psychologically or cause any other harm to any other
student.
7. I have fully understood that, if found indulging or guilty of any aspect of ragging within or
outside AIIMS campus. I may be punished as per the provisions of the AIIMS Regulations/
Directives mentioned above and f or as per the law in force for which, I will be solely
responsible and shall not claim anycompensation.

Deponent

Signature ofParent

VERI FICATION: verified at on this-day of-2020.

That the above affidavit is true and correct.

Name: Address & Contact No.: Deponent

Signature of Parent
 APPENDIX - D

DECLARATION BY THE CANDIDATE

Son/Daughter ofSh.

Village/Town/City

DiSt

State_. hereby declare that I belong to the Government of India for

the purpose of reservation in service as per orders contained in Department of Personnel and
training office Memorandum No. 36012/2293.Estt. (SCT) dated)/ 08.09.1993. It is also
declared that I do not belong to persona / section [Creamy Layer) mentioned in column 3 of the
Schedule to the above referred Office Memorandum dated 08-09 -1993.

Name:

Signature ofthe Candidate:

Address:
 APPENDIX - E

UNDERTAKING BY TIIE CANDIDATE

S/O, D/Oof Mr./Mrs.

have passed MBBS Entrance Examination held on

I certify that all my Original Certificates (i,e 10tt Passed/Age Proof, l-2th Passed Marks
Sheet & Certificate and Scheduled Caste/Scheduled Tribe [SC/ST) Other Backward Classes[OBC)
are authentic. If anything found false, then my candidature may be treated as
withdrawn/cancelled at any time during the course.

Name:

Signature ofthe candidate:

Address:
 AflfiE hIUJX* F
PROFORMA FOR SCHEDULED CASTqSND SCHEpULEp T_gtBE cERTtFtCATE

Form of certificate as prcscribed in M.H.A., o.M,, No. 42/21/49-N.c.s. dated the 28.1.19s2, as
revised in Dept. of
Per- & A'R. letter No' 1601'2/6/16-Est. (S.CT), dated the 29.LO.7977, to be produced by candidate
belonging ro a
Scheduled Caste or a Scheduled Tribe in support of his/her claim.
CASTE CERTIFICATE
This is to certify that Shri/Smt./Kum son/daughter* of --------_-_----_-____-------of
village/torvn*- ----- ,in djstrici/Division*- -,,- --------of the staie/union Territory*
belongs to the------------------cirste/ Tribe which is recognized as a Scheduled Caste/scheduledrribe*under:
. The Constitution (Scheduled Caste) Order, 1950
. The Constitution (Scheduled Tribe) Order,1950
. The Constitutir:n (Scheduled Caste) (Union Territories) Order,195L
o The Constrtution (scheCuled Tribe) (Union Territories) Order,1951
1. (as anrended by the Scheduled Caste and Scheduled Tribe Lists (N4odification) ordrr,1956, the Bonrbay Rc-
organization Act, 1960, the Pun.jab lle- orgrnization Act, 1966, rlre Stare of Hinrachal pr;:desh Act,
1970 the North
Eastern Areas (Re-organizationJ Act, 1971 arrd the Scheduied Castes and Scheduled Tribes orders, (Amendment)
Act,
1.e7 6).
. The Constitution (Jammu antl Kashnrir) SchedLrled Caste Orcler, 1956,
r The Constitution (AndJman and Nicobar rslands) scheculed rribes order, 1959.
o The Constitution (Dadra and Nagar Haveli) Scheduled Caste Order, 1962.

' The constitutlon (Dadra and Nagar Haveli) scheduied Tribes, order,1962.
. The Constitution (puducherry) Schedu ed Caste Order, 1964
. The Constitution (Uttar pradesh) Scheduled Tribes, Order, 1967.
o The Constitution (Coa, Daman & Diu) Schedulr:d Caste Order, 196g.
. The Constitut;on (Goa, Daman & Diu) ScheduleC Tribes, Order, 196g_
. The Consr;tution (Nagaland) Scheduled Tribes Order, 1970.
.
The Constitrrtlon (Sikk m)Scheduled Caste Order, 197g.
r
The Constitution (Sikklm) Scht-'cluled Tribr:s OrcJer, 1978.
2. Applicable in the case of Scheduled Caste/Schedule Tr ber persons rvho have migrated from one State/union
Territory Adminlstration:
This certificate is issued on the basis of the scheduled caste/Scheduled Tribe* certificate issued
to shri/Sn11*----------
,-father/rrotirerofShri/Smt/Kum* -.._.,. ......cf viltage/town*
----- in District/Division* ,-,---,--of tIe Srate/UnionTcrritory*---, _,.-_-_ who belongs to the _---
-------caste/tribe which is recognized as a Scheduled Caste/Scheduled Tribe* in the
State/Union
rcrrrLUry ---issuedbythe----------- (nanrcof prescribedauthority)videtheirNo--
- date
3. Shri'/Smt.*/Kum* -------------------------and/or his/hert famrly orclrnary reside (s) in villege/town*
------__-_-- -----_-_of
the State/Urrion Territory of ------------- --.

Signaiure,

Place--------------------State/UnionTerritory *+Designali6n
Date -----------.------- (U/ith seal of Office)
+ Please delete
the urords which are not applicable.
o Please quote specific presidential Order.
. Delete the paragraph which is not applicable.
** Should be signed by the Authorities empowered to issue Schedulecl Caste/Scheduled Tribe certifjcates as
specified a bove.

55
 Apfrnrorx_ Q
PROFORMA FOR OTHER BACKWARD-CLASS (OBC-NCL) CERTIFICATE
(Certificate to be produced by Other Backward Class applying for admission to Central Educational lnstitute (CEIS)
under
the Government of lndia)

This is to certify thar Shri/Smt./Kunr./Dr Son/Daughter cf

S h rilDr. of Village/Town District/Division in the
State beiongs to the .Conrmunity which is recognrzed as a backward class under:
(i) Resolution No. l-2011/68/93-BCC(C) datcd 1O/09/93 published in the 6azette of lndia Ixtraordinary part I Sect]on I

No. 185 dated 13/09/93.

(ii) Resolution No. 12011/9/94-BCC dated 1911.A/94 pubiished in the Gazette of lndia Extraordinary part I Secrion I No.
163 o..rted 20llA/9a
(iii) Resolution tla,12011.17/95-BCC dated 24la5l9s published in the Gazette of Ind a Irrrrordrnary part I section I l,]o.
88 dated 25/05/95,
(iv) Aesolution No. 120i1/96/9.1-8CC dated 09/C3r96,
(v) Resolution No 12011/44/96-BCC dated aGl1.2l96 published in the Gazette of Indta Extraordinary par-t I Section No.
120 dated 11/12l96.
(vi) Resolurion No. 12011/13/97-BCC dared 03l1.2l97.
(v i) Resolution No, 12.011199/94-BCC dated t1lt2/97.
(vrii) Resolution No. 1201116E/98-BCC dated 21l1.Olgg.
(ir) Resolution No. 12011/U8/98-BCC dated a6/12lgg pLrblished in the Gazctte of India Exiraordrnary part I Section I No.
270 dated 061),2199.
(x) Resoir..rtion No, 12011/36/99-BCC dated 04/0,1/2000 published in the Gazerte of lndia Extraordinary part tsection I

No. 71 dated A4 /A412004.

{xi) Reso ution No. 12011/44199-BCC dated 2IlA9/2OCO pLLblished in the Gazette of tnrjia Extraordinary part I Section I

No. 2 10 dated 21109/2C00.

(xii) Resolution No. 12015/09/2000 BCC dated C6/09/2001.
(xiil) Resolution No. 12011/0j/2001-BCC dated 19i06/2003.
(rlv) Rcsolution No. 1201i/0al2002-BCC dated 13/0i/2C0,1.
(ru) Resolution No. 12011109/2004 BCC dated 16/01i 20116 pu5lishr:d in the Gazette of lndia Extraordinary part I Section
I No,210 dated 15/D1/2006.
(xvi) Resoiution No. 20012/129/2009/-BC-il dated 0.1/03/2014 pub ished jn the ctszette of Ind a Exti.aordinary part I

sectior I no.63 dated 041A3/2014,

Shri/Smt./Kunr. _____and/or his fanrily ordinarily reside(s) in the

District/Division of St a te.
This is aiso to certify that he/she does not belong to
pcrsons/section icreamy iayer) mentioned in Column 3 of the
t1.re
Scheculed to the Government cf lncia, Department of Personnel & Training
O.tu1. l.to. 36An/22193-Estt. {SCT) dated
08/09/53 which is modified vicle oM No, 36033/3/2004 Estt. (ltes.) dated 09.03,2004 or the latest notification of the
Government of lndia.
D,l ted:
District Magistrate/Conrpctent Authority Seal
NOTE:
(o) The Term ordinarily used here will hove the some nteoning os in Section 20 ol the Representotion of the people
Act, 1950.
(b) The outhorities competent to issue coste certificates ore indicoted below:
(t) District Mogistrate/Additionol Mogistrote/tst Ctoss Stiptndiory Mogistrote/sub-Divisianal Mogistrote/Toluka
Mogistrate/Executive Mogistrate/Extro Assistont Commissioner {not betow the ronk of t'. Class Stipendiory
Magistote.)
(ii) Chicl Presidency Mogistrote/Additionol Chief presidency Mogistrote/presidency mogistrate,
(ii) Revenue Oft'icer not betow the ronk of Tehsildor.
(ru) Sub-Divisionol ot'licer of the areo where the condidote ond/or his fomily resides.
{r) The onnual income/stotus of the porents of the opplicont shoutd be based on
finonciol year ending Morch 37, 2021.

56
 Proforma for EWS Certificate APrE heT}TK -H
,7

Governnrent of
(Name & Address of the authority issuing the certificate)

INCOME & ASSEST CERTIFICATE TO. BE PRODUCED BY ECONOMICALLY WEAKER

SECTIONS

Certiflcate No. Date:

VALID FOR THE YEAR

This is to certifly that Shri/Srnt./Kumari son/daughter/wife of

permanent resldent of , Village/Street
Fncf Affina Dlstrict.--_..--- in the State/Union Territory
Pin Code vrhose photograph is attested below belongs to
Economically Weaker Sections, since the gross annual income" of his/her 'family"i. is belorv Rs. 8
lakh (Rupees Eight Laktr only) for the financial year _. His/lrer family does not own or
possess any of the following assets*** :
l. 5 acres of agricultural land and above,
ll. Residentialflat of 1000 sq. ft. and above;
lll. Resldential plot of 100 sq. yards and above in notifled municipalities;
lV. Residentlal plot of 200 sq. yards and above 1n areas other'ilran the notified municipalities.
2. Shri/Smt./Kumari belongs to the caste which is not
recognized as a Scheduled Caste, Scheduled Tribe and Otlrer Backward ClasseJ (Central List)

Signature with seal of Offlce

Name
Designation

Recent Passport size

attested photograph of
the'appiicant

'Note1:. lncome covereci ail sources i.e, salary, agriculture, Uusineis, proressicn, etc.
*Note 2:The term "Family" for this purpose include lhe person, vJho sceks benefit of resenratlon, hislher parents and siblings below the age
of 1B years as also his/her spouse and chlldren i:elow tite age of 10 years

**-Note 3: The property

held by a'Family" in rlif{erent locatlons or different places/cities have been clubbed while applying the land or
prcperty holding test to determlne EfJS status.

57