Modified Thesis Submission Form & Guidelines - 2015

For Office Use Only
THESIS SUBMISION FORM

MODIFIED THESIS
General Instructions :
 Incomplete submission forms will not be considered.
 Complete the form enclosed in BLOCK LETTERS only.
 Use Black/Blue Ball pen only to fill up the form.
 In case of modified thesis, a fee of Rs. 1800/- will be paid by candidates along with
re-submission of their thesis.
(Fee can be paid at any Indian Bank Branch across India through pay-in-slip/challan.
NBE copy of challan in original has to be affixed with this form.)
 Along with your thesis, send the summary of your thesis as per the earlier format in
hard copy. No soft copy for thesis is required.
 Any change in your correspondence address after submission of thesis should be

intimated to NBE at email thesis@natboard.edu.in, reg@natboard.edu.in and
final@natboard.edu.in so as to affect timely dispatch of the outcome for your thesis
assessment and other communications.
 For inquiries pertaining to thesis, you may write to thesis@natboard.edu.in No

inquiries regarding thesis assessment status prior to 4 months after thesis
submission will be entertained.
 Mention your Name, Subject, Registration No. and Date of submission of thesis in
any correspondence pertaining to thesis with NBE.
GUIDELINES FOR SUBMISSION OF MODIFIED THESIS:
 Thesis submission and its acceptance are mandatory requirements towards
fulfillment of partial criteria for award of DNB degree certificate.
 Thesis must be modified strictly in accordance with the observation made by the
assessor.
 Modified thesis should be hard bound and the front cover page should be printed in
the standard format. However, it should be labeled as MODIFIED THESIS.
 A hard bound thesis should be accompanied with:

o A summary of thesis and modification incorporated.
o Form for submission of Modified thesis, duly completed
o NBE copy of challan towards payment of re-assessment fee (Rs 1800/-) in
original.
 A declaration of thesis work being bonafide in nature and done by the candidate
himself at the institute of DNB training need to be submitted bound with modified
thesis. The certificate must specify that thesis have been modified as per suggestion
of the assessor. This certificate must be signed by the candidate himself/herself, the
thesis guide and head of the institution, failing which thesis shall not be considered.
 Modifications done in the thesis should be appropriately flagged.
 Modified thesis is required to be submitted within 6 weeks of issuance of the

communication.
 Candidates are advised not to canvass with NBE/assessor for assessment of thesis.
A. GENERAL INFORMATION
1. Name (in full) :

Paste here
………………………………………………………………………………………………………….. (Do not pin or
staple)
2. Father’s/Husband’s Name :
A recent passport
………………………………………………………………………………………………………….. size photograph.
3. Correspondence Address :
………………………………………………………………………………………………………………………………………………
…………….…………………………………………………………………………………………………………………………………
………………………….…………………………………………………………………………………………………………………
Telephone No…………………………………………..Mobile No…………………………………………………………
4. Permanent Address:
………………………………………………………………………………………………………………………………………………
…………….…………………………………………………………………………………………………………………………………
….…………………………………………………………………………………………………………………………………………
Telephone No…………………………………………..Mobile No…………………………………………………………
E-mail …………………………………………………………………………………………………………………
5. Fees Details:
Bank Challan/Transaction ID No…………………………Date………………………..Amount Rs………………
Name of the Bank &Branch…………………………………………………………………………………………………….
B. DNB TRAINING DETAILS
6. Registration Details
a) Reg.No. ……………………………………………………………………………………………………………………………..
(Attach a copy of letter of registration issued by NBE)
b) Date of Joining ………………………………………………………………………………
c) Date of Completion of DNB training ………………………………………………
Subject
Institute/ University
State
Period of Training
Correspondence Address of the Institute :
Information about the Dissertation/ Thesis
Title
Area of Specialty
(Medicine, surgery
etc)
Guide Name and Designation Qualification Primary
place of
Practice
Thesis Guide
Co-guide (if any)
7. Please check the enclosures with modified thesis:

 A summary of thesis and modification incorporated.
 Form for submission of Modified thesis, duly completed.
 NBE copy of challan towards payment of re-assessment fee (Rs 1800/-).
This is to certify that the work undertaken by

Dr………………………………………………………………………………….at(Institute)……………………………………………………
….………………………………………………………………………………………………………………under supervision of ( Name
of guide)……………………………………..…………………...............is his/her bonafied work and free from
plagiarism. The modifications in the thesis work have been undertaken as per the observations of the
assessor. We understand if any unethical practice is detected in thesis, the same is liable to get
rejected and the candidate may be debarred from DNB final examination and/or any further
disciplinary action may be taken as decided by NBE.
Signature of the candidate

(Forwarded through approved channels)
Signature of HOD
(MANDATORY)
Signature of Thesis Guide/Co-Guide
(MANDATORY)
Signature and stamp of Head of Institution

(MANDATORY)

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THESIS SUBMISION FORM

 Complete the form enclosed in BLOCK LETTERS only.

 Use Black/Blue Ball pen only to fill up the form.

 Any change in your correspondence address after submission of thesis should be

 For inquiries pertaining to thesis, you may write to thesis@natboard.edu.in No

 A hard bound thesis should be accompanied with:

 Modifications done in the thesis should be appropriately flagged.

 Modified thesis is required to be submitted within 6 weeks of issuance of the

1. Name (in full) :

B. DNB TRAINING DETAILS

Co-guide (if any)

7. Please check the enclosures with modified thesis:

This is to certify that the work undertaken by

Signature of the candidate

Signature and stamp of Head of Institution

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