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CHECK LIST FOR MBBS ADMISSION-2020

Admission Rank NEET ROLL NEET NEET Candidate ALLOTTED
Quota NO SCORE PERCENTILE Category CATEGORY
NEET CEE/ (GN/SC/ST/OEC
AIQ/SQ/ All State /OBC/PH/
/Nominee India Otherspecify)

(Documents shall be arranged in the following order)

Sl No. Document Office Use
a) Allotment Memo (MCC/CEE)- 3 copy
b) Admit Card (NEET UG 2020)
c) Rank letter (NEET,CEE)
d) Mark Data Sheet (NEET/CEE)
e) NEET Result Sheet
f) Document to Prove Date of Birth
g) Original receipt of fee
h) 10th pass certificate
i) 10th mark list (CBSE, ICSE -if any))
j) 12th pass certificate
k) 12th mark list (CBSE, ICSE -if any)
l) Transfer Certificate
m) Course & Conduct Certificate
n) Caste Certificate in case of Reservation Category
o) Eligibility certificate (if required)
p) Migration Certificate ( if required)
q) Equivalence Certificate( if required)
r) Physical Fitness Certificate obtained from a Medical Officer in
Service not below the rank of an Asst.Surgeon(Format given in
the Annex.XVII(b) of the Prospectus 2020
s) Vaccination certificate ( Hepatitis B,MMR & Chicken pox )
t) Disability Cerificate (if required)
u) Bond

Signature of Candidate with Date:

Name

NB:- Two Stamp size photographs (One should be pasted in biodata) Two set Photocopies of
all documents and a transparentplastic folder having address slip of the student in order to
keep the certificates in safe custody.

*Attention:-SC/ST, OEC candidates (Keralites)should apply for fee concession through

online (E grantz)within one week after starting the class. Otherwise they will be liable to pay
full fees with fine.
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Declaration I

I hereby declare that I will submit the following documents within the prescribed
time as per norms of DGHS/NBE/DME/CEE/MCC/MCI.Failing which I am fully
responsible for the termination of my provisional admission.

I am fully aware that any violation found in the procedure of submission of bond
as specified in the prospectus of 2020 or by any Government order in force will lead
to the termination of my provisional admission and do hereby declare that I am solely
and fully liable and responsible for the same and as it is a lapse from my own side, I
do not have any claim for my admission and never ever proceed to any legal
procedure against my declaration.

1.
2.
3.
4.
5.

Signature of student with date:

Name:
Address :
Date:

*SPECIAL ATTENTION*
Fee concession and Refund of fee is availed through E-Grants Scholarship.Hence
SC/ST/OEC(No Income Limit)SERBC/FC(Below one Lakh)students(Kerala) should
apply for E-grantz Scholarship through Akshya centre with in one week after starting the
class and submitt the hard copy of application along with the relevent documents in
Academic Section(B6 seat) in time otherwise college fee will be lieved as usual.
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BIO-DATA-MBBS 2020
Name of Candidate
with initials (as entered in 10th pass
photo
certificate) &Photo

Sex M / F
Date of Birth
Religion, community and caste
Whether SC / ST / OEC/PD
Mother tongue
Name of entrance exam appeared NEET/ OTHERS
Rank number and Roll number
Allotted Category SM/SC/ST/OBC/OEC/PH/Nominee/Other specify-----------
Qualifying
exam:(+2/HSC/CBSE/ISC)
Register No: / Roll No; Month and
year of passing qualifying exam:
School where educated (12th)
Name of authority issued pass
certificate of the qualifying exam:
(Govt of Kerala/CBSE/CISCE etc)
Present Address with pin code

Address for Communication

with pin code
Land Line Number &Mobile Number
E-mail id
Marks obtained by the candidate in the qualifying examination(+2)
Physics + Chemistry + Biology Maximum marks % of Marks

…….... +...….. + …….. =............ ........................... ................

Maximum marks % of Marks
Biology alone ...................
................. .................
Maximum marks % of Marks
English alone ................
.......................... ....................
Marks obtained by the candidate in the qualifying entrance examination(NEET)
Name of entrance exam Marks Maximum NEET NEET Percentage
NEET/ Other obtained Marks Percentile
Specify............................
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Name of Parent / Guardian

Address of Parent / Guardian

Mobile Number of Parent / Guardian

Name and address of local guardian

(if any) with contact number

Declaration
1. Details mentioned above are true to the best of my knowledge and belief.
2. I ………………………………………………., the undersigned , as a student
of the Government Medical College, Thiruvananthapuram hereby agree with the Chief
Secretary to the Government of Kerala, his successor and assignees to confirm from this
date to the rules and regulations including these relating to the hostel if I am admitted to
laid down or to be laid down here in after by the Chief Secretary to the Govt: of Kerala
or the Principal, for the time being of Government Medical College,
Thiruvananthapuram for the due maintenance of discipline at the said Medical College.
3. I further agree with the said Chief Secretary to the Government of Kerala his
successors and assignees to make good when called upon to do so to the Government of
Kerala any damage to the furniture, apparatus or other things which may be caused by
any carelessness, negligence or wantonness on my part.
4. I further agree that in case it is found that I had secured admission by adopting
or resorting to fraudulent means, my admission will be cancelled and my name will be
removed from the rolls.
5. In witness where of I have hereunto set my hands on this day.........................
at Govt.Medical College,Thiruvananthapuram.

Signature with name and date of the student

Signature with name and date of Parent / Guardian

With Name and Adress
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ANNEXURE- XXII
UNDERTAKING FROM THE STUDENTS AS PER THE PROVISIONS OF ANTI –
RAGGINGVERDICT BY THE HON’BLE SUPREME COURT OF INDIA
(See clause 14.4)

I, Mr / Ms................................................................................., Roll No.......................... Program :

........................................................................ student of Government Medical College,
Thiruvananthapuram do hereby undertake on this day...........Month.......................................
Year............................, the following with respect to above subject and Office Order No:
B1/8031/2017/GMCT Dated:

1. That I have read and understood the directives of the Hon’ble Supreme Court of India on anti
– ragging and the measures proposed to be taken in the above references.

2. That I understand the meaning of Ragging and know that the ragging in any form is a
punishable offence and the same is banned by the Court of Law.

3. That I have not been found or charged for my involvement in any kind of ragging in the past.
However, I undertake to face disciplinary action / legal proceedings including expulsion
from the institute if the above statement is found to be untrue or the facts are concealed, at
any stage in future.

4. That I shall not resort to ragging in any form at any place and shall abide by the rules / laws
prescribed by the Courts, Govt. of India and institute authorities for the purpose from time to
time.

...................................
Signature of student with date

I hereby fully endorse the undertaking made by my child / ward.

...............................................
Signature of Mother / Father and or Guardian

Witness :......................................................( Signature, with Date)

Name:
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PROFORMA FOR ONLINE REGISTRATION FOR MCI & KUHS

(Fill carefully )

1 NEET EXAM ROLL NUMBER

2 DATE OF ADMISSION
3 COURSE MBBS
4 NAME OF STUDENT ( AS IN THE 10TH
CERTIFICATE)CAPITAL LETTER
5 SEX (TICK) M / F
6 DATE OF BIRTH (DD/MM/YYYY)
7 CANDIDATE CATEGORY (TICK) GEN EZ MU BH LC

BX KU SC ST OBC
AI OEC
RELIGION (TICK) HINDU X'AN ISLAM NO OTHERS
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RELIGION
9 CASTE
11 ADMISSION QUOTA
(AIQ, CEE Kerala, Nominee, Other Specify)
SUB QUOTA(XA,DK,DA,DH,NQ,SP,Other
Specify
12 ALOTTED CATEGORY
(GN /OBC/SC/ST/ OEC/ PH/ Other Specify)

13 PHYSICALLY HANDICAPPED YES / NO

14
MARKS OBTAINED 10+2 PCB Physics........ + Chemistry............+ Biology............=

MAXIMUM MARKS 10+2 PCB Physics....... .+ Chemistry............+ Biology............=

15 MARKS OBTAINED 10+2 ENGLISH
MAXIMUM MARKS 10+2 ENGLISH
17 MARKS OBTAINED IN ENTRANCE EXAM
MAXIMUM MARKS IN ENTRANCE EXAM

18 NEET ALL INDIA RANK (AIQ)

STATE MEDICAL RANK(CEE/STATE)

19 NEET PERCENTAGE %

NEET PERCENTILE SCORE

20 AADHAR NUMBER

21 STUDENT MOB

22
SINGATURE WITH DATE
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സ‍ര്‍ക്കാ ര്‍ മെഡിക്ക‍ല്‍ ക ാകേജ്,തിരുവനന്തപുരം

ത വന
സതയപ്പസ്ാ

തിരുവനന്തപുരം സ‍ര്‍ക്കാ ര്‍ മെഡിക്ക‍ല്‍ ക ാകേജി ല്‍................................................................. ക ാഴ്സിന്

പഠിക്കുന്ന................................................................................

......................എന്നഞാന്‍ എന്‍മെ പഠന ാലത്ത് ഈ സ്ഥാപനത്തില്‍ ൊഗിംങ്ങിമന ഒരു

വിധത്തിലും അനു ൂലിക്കു മ ാൊഗിംങ്ങ് നടത്തു മ ാ മെയ്യുന്നതമെന്നും

ൊഗിംങ്ങിമനതിമര പ്പവ‍ര്‍ത്തിക്കുന്നതാമെന്നും പ്പതിജ്ഞ മെയ്യുന്നു. ൂടാമത ൊഗിംങ്ങുൊ ി

ബന്ധമെടു ാമെങ്കി ല്‍ അധി ാരി ‍ള്‍ സവീ രിക്കുന്ന എതു നടപടിക്കും

വികധ ൊ ുന്നതിന് സമ്മതൊമെന്നും പ്പസ്താവിക്കുന്നു.

എന്ന്

(വിദ്യാര്‍ത്ഥി)

കെല്‍െെഞ്ഞിരിക്കുന്ന ാരയങ്ങ‍ള്‍ വിദ്യാ ര്‍ത്ഥി ുമട രക്ഷിതാവാ എനിക്ക് സമ്മതൊമെന്ന്

അെി ിക്കുന്നു.

രക്ഷ ര്‍ത്താവ്
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