Declaration Form

Documents: 

I. DECLARATION
Those who have not completed the internship on the date of submission of application have to sign the declaration by the candidate as mentioned below:

I, Dr. ______________________________________ hereby declare that I am undergoing internship as part of MBBS course from ________________________________ and will be completing the internship on _________________. In case, I am in the provisional list of candidates for admission to MD courses, I will submit the internship completion certificate on or before 31-03-2014, failing which I will have no claim over admission and the University is at liberty to allot the seat to other eligible candidate as per rules and regulations.
Signature of the Candidate

INTERNSHIP DUE CERTIFICATE
Those who have not completed the internship on the date of submission of application have to get the certificate signed by the Principal / Dean as mentioned below:

This is to certify that Dr. ___________________________________ is undergoing internship at _____________________________________________________ and will be completing the internship on ___________________. The above certificate is issued to enable the candidate to appear for the SVIMSPGET – 2014 entrance examination.
Place: Principal / Dean
Date: with seal

II. NOC from the Employer under whom the Applicant is employed (Only for those candidates who are in Employment - Govt. / Private Sector)
Forwarded
This Institution / organization has no objection for allowing Dr.____________________ _______________________________________________________ to apply for MD courses at SVIMS. In the event of his / her selection for admission to the course applied for, he / she will be relieved immediately from this institution / organization to join the course by the prescribed date. The undersigned is duly empowered and authorized to sign and issue this no objection certificate.
Place: SIGNATURE
Date: DESIGNATION
(with office seal)
III. RESIDENCE CERTIFICATE
This certificate should be furnished by only such candidates who have not studied in any recognized educational institution / medical college during the whole or any part of seven consecutive academic years in Andhra Pradesh immediately preceding the qualifying examination. i.e. Intermediate (+2) & MBBS).
ADMISSION TO M.D. COURSES
1. It is hereby certified
a) That Dr.__________________________ S/o, D/o________________________ a candidate for admission to the M.D. course appeared for the first time for the ______________________ examination (being the minimum qualifying examination for admission to the course mentioned above) in ____________ (month) _______________ (year)
b) That he/she has not studied in any educational institution during the whole/ a part of the seven consecutive academic years ending with the academic year in which he/she first appeared for the aforesaid examination.
c) That in the seven years immediately preceding the commencement of aforesaid examination he/she resided in the following place/places falling within the local area in respect of the ___________________________ * University, namely.
S. No.
Village
Taluk/Mandal
District
Period
1.
2.
3.
4.
5.
6.
7.
2. The above candidate is therefore, a local candidate in relation to the local area specified in paragraph 3(1)/3(2)/3(3) of the Andhra Pradesh Educational Institutions (regulation of Admissions) order, 1974.
* Andhra (Nagarjuna) / Osmania (Kakatiya) / Sri Venkateswara
Office Seal To be signed by the Officer of Revenue Department
(Not below the rank of Tahsildar)