Application for MBBS Course 2012-13 - Pariyaram medical College

II.Eligibility Criteriaa. Candidates must be citizens of India who have passed Higher SecondaryExamination of the Board of Higher Secondary Education of Kerala or equivalentexaminations recognized by the Universities in the State of Kerala/ Kerala Universityof Health Sciences. Candidates should have secured an aggregate of not less than50% marks in the optional subjects of chemistry, physics and biology and separateminimum 50% marks for Biology.b. Candidates who have passed their qualifying examinations from authorities otherthan the State of Kerala shall produce the certificate of recognition and theequivalency of the qualifying examination.a. AGEApplicants should have completed 17 years on 31st December 2012. No relaxationof the minimum age will be allowed.c. HOW TO APPLYa. Application Forms:Cost of application form for MBBS will be Rs.1000/-. Application form on payment ofRs.1000/- will be available from the Office of the Principal (Medical College), ACMEPariyaram on all working days from 10 A.M. to 5.00 P.M from 01/06/12 onwards.Application are available on website also (www.mcpariyaram.com). Downloadedapplication should be accompanied by Application fee (Demand Draft) for Rs.1000/-payable to Principal, Academy of Medical Sciences, Kannur. Online submissionfacility is not provided.b. Certificates/documents to be produced along with the filled application form.1. Attested copy of the mark list of qualifying examination2. A self addressed stamped envelope (12 X 25 cms size) with Indian Postalstamps worth Rs.5/- affixed thereon.3. Attested copy of relevant page of School records namely SSLC/ISC/CBSEcertificate showing the date of birth should be furnished along with theapplication as proof of age.4. Certificate of Nativity5. Attested copy of mark list of Common Entrance Examination (CEE)

The filled in application forms with all the required certificates/documents shall be submitted tothe office of the Principal, Academy of Medical Sciences, Pariyaram, Kannur on or before 5PM on15/06/12.Applications submitted should be complete in all respects and the certificates produced after thelast date of receipt will not be considered.d. PROCEDURE OF SELECTION35% of the total seats (35 numbers) to be filled by the Management as per the rank list ofCommon Entrance Examination marks prepared from the applicants applied for admissionto ACME, who have qualified the Common Entrance Examination 2012 conducted by theCommissioner of Entrance Examination, Government of Kerala.The date of commencement of the Course and the last date of admission process will be asper the time schedule fixed by the Government of India/Medical Council of India/SupremeCourt of India.e. FEESFees structure for MBBS for the whole duration of course will be as per the norms framedby the Government of Kerala; or Admission Supervisory Committee; or the Hon’ble HighCourt of Kerala, or any other body appointed by the Government of Kerala, for the purpose.The fees payable for the course should be remitted at the time of admission andperiodically each year. Fee relaxation is not given to any candidate. Students admittedunder merit allocation by government of Kerala may pay the fees prescribed bygovernment and student admitted under management will remit the fees notified bymanagement to each course.f. SPECIAL FEATURESa. All students who get selected should be vaccinated against hepatitis beforeadmission. A certificate to the effect has to be submitted at the time of admission orbefore commencement of the course.b. If any candidate discontinues/leaves the Institution within a period of 15 days beforethe closing of admission in the first year or discontinues/leaves the Institution in thesubsequent years, he/she is liable to pay the fees for the remaining years i.e. fees forthe whole duration of course. In such cases Transfer Certificate and other certificatesof the student concerned will be issued only after the payment of the fees for theremaining years are also made.

c. The applicants selected for MBBS Courses will have to execute a bond in a hundredrupees Kerala Stamp Paper at the time of joining the course to the effect that he /she shall not discontinue the course after admission and be liable to pay liquidateddamages on vacating the college and consent to pay the fees of institutionperiodically on time. Likewise, candidates will execute in the bond that he/she willpay the fees which has been informed during admission.Course Duration: Course duration comprises of 4 1/2 years academic programme and 12 monthsof compulsory Rotating Resident Internship (House Surgeoncy)VIII.DISCIPLINEa. All students who are selected should obey the rules & Regulations of the Institutionwithout failb. They should wear prescribed uniform with name plate on the chest during workinghoursc. Any type of ragging in the campus is strictly prohibited. If a case is reported against astudent he/she will be given chance to explain himself/herself and if the explanationis not satisfactory he/she will be expelled from the institution/suitable punishmentgiven without further notice. Other criminal/ legal procedures will also be allowed.d. Mobile phones are not permitted at the academic areas and hospitalse. No scholarships for any or admission reservations for SC/ST/OEC given.f. The candidates should satisfy the eligibility conditions on the date of submission ofapplication formg. All candidates should read and sign the declarationh. Incomplete/ defective/late Applications will be rejected.i. Attendance & Leave: A minimum of 80% attendance in each academic year iscompulsory. (separate for theory and practicals)j. Rules and regulations as prescribed should be strictly followed at the college,hospital and hostels.k. Smoking and alcoholic drinks are totally prohibitedl. All students admitted will be insured against illness/ accidents through NationalInsurance Scheme every year for whole duration of course and premium payable willbe collected from the student concerned.

m. Applicants shall obtain acknowledgement from the college office for the applicationssubmitted in person at the respective Colleges.n. Photocopies of Certificates/Documents attested by a Gazetted Officer or the headof the Institution last studied to be submitted along with the application.Students are expected to dress up neatly and decently. Jeans, Baggies T Shirts and the likes arenot permitted to be worn inside the hospital/college.Students are expected to observe absolute discipline in their conduct during the entire periodthey spend in the institution. Failure to observe absolute discipline will invite appropriate action.PRINCIPALACME, Pariyaram

ANNEXURE- IIBOND(Total Value of ` 100/- Kerala Stamp Paper)To be executed by all candidates admitted to MBBS Course at Pariyaram Academy ofMedical Sciences, Pariyaram, Kerala.TO KNOW ALL MEN BY THESE PRESENTS, that we ………………………………………….…………………………………………………………………………………. Residingat…………………………………………………..hereinafter called the ‘Bounden’ (whichexpression shall unless excluded by or repugnant to the context include his heirs,executors, administrators and legal representatives) and………………………………………….and……………………………… hereinafter called the firstsurety and second surety respectively (which expression shall unless excluded byrepugnant to the context include their respective heirs, executors, administrators andlegal representatives) bind ourselves jointly and severally to pay the Principal, Academyof Medical Sciences, Pariyaram, Kannur (hereinafter called the College) on demandwithout demur a sum of `………………………………….(Rupees…………………………………………………….)the(Rupees…………………………….……………..) as liquidated damages, if discontinue thecourse after admission.Signed this ……………………….…… day of ………………………… in the year 2012……………………by the Bounden Sri………………………………. ………………………….………………………………………………………………………………………..(Full address)In the presence of witnesses: (Name & Official Address iscompulsory)…………………..............................................................................….……………………………………………..……………………………………………………….Now the condition of the above written obligation is that in the event of the progress ofstudy Bounden interrupting or discontinuing course, at any time after the admission isliable to pay on demand and without demur all the amount spent on the Bounden onaccount of the said course of studies, together with the liquidated damages of`………............................……………………….(Rupees………………………………………………………………) Indiscipline or misconduct on thepart of the Bounden as also the amount of compensation payable and as to whether theBounden has or has not performed and observed the conditions and Boundenobligations under these presents shall be final and Binding on the Bounden and thesureties.Provided further that the Bounden and the Sureties do hereby agree that all sums founddue to the College under or by virtue of this bond may be recovered jointly and severallyfrom them and their prospective movable and immovable as if such sums were arrearsof land revenue under the provisions of the Revenue Recovery Act for the time being inforce or in such other manner as to the College may deem fit.It is agreed that the liability of the sureties hereunder shall not be impaired ordischarged by reason of time being granted or any forbearance, act of omission of theCollege (Whether with or without the knowledge or consent of the sureties) in respect orin relation to the several obligations and conditions to be performed or discharged byBounden or by any other matter or thing whatsoever which under the law relating thesureties, shall but for this provision have the effect of releasing the sureties from suchliability not shall it be necessary for the College, to sue the Bounden before doing eitherof the sureties for amounts due hereunder. It is further agreed that Bounden andsureties do hereby agree to pay fees regularly and will not engage in litigation againstpayment of fees.

It is agreed that the expense of Stamp duty to this document shall be borne by theBounden.IN WITNESS WHEREOF the Bounden……… …………………………….……………………………………………………………………………………………….…………………………….and………………………………………………………………………………………………….. and………………………………………………………………………sureties have put their respectivehands the day and year herein above writtenSigned by the Bounden in the presence of witness:(Signature of the Bounden)1. Signed by…………………………………………………….(Signature of the sureties) (Residential Address of the sureties Compulsory)Signed by………………………………….(Signature the witness)(Official Address & Residential Address of the witness is Compulsory)OFFICE SEALWitness must be parent/guardian/husband/wife or serving state government officer orcentral government officer. The signature of the candidate and sureties have to beattested by a gazetted officer. The documents proving the relation of the surety tocandidate or employment certificate of the state/central government officer shouldaccompany bond.

ANNEXURE I. CERTIFICATE TO PROVE NATIVITYI (a. Certificate of Birth/ Residence)[To be signed by the Village Officer/Tahsildar in Kerala State]Certified that, Sri/Smt………………………………………………………… ………… anapplicant for admission to MBBS course 2012-13 at Academy of MedicalSciences, Pariyaram, Kannur, Kerala is the son/daughter ofSri/Smt……………………………………………………………of……………………House………………………………………………………………..Village,………………………………………………. District and was born in Kerala.ORCertified that the applicant Sri/Smt……………………………………………………………has been a Resident of Kerala State for a period of 5 years withina continuous period of 10 years.Place:Date:Signature of the Village Officer/ Tahsildar:Name:Village/Taluk:District:(Office Seal)

Application No:Date of Receipt:Name of Candidate(In BOLD LETTERS)Application for MBBS Course 2012-13-Management Quota-Sex Male Female Date of Birth(as in your 10 th Certificate)Paste one selfattested passportsize recentcolor photograph(face close up)Paste : Do not pinor stapleCasteAgeCommunitySex (M/F)Do you belong to SC ST OECNationalityDetails of Parents Father MotherNameOccupationAnnual IncomeDetails of Qualifying ExaminationNameName of the Institution (with place) in which candidate studied for +2 exam :Reg. No.Month & Year of passingMarks secured in Physics, Chemistry, Biology & English in the Qualifying examination.Physics (I) Chemistry (II) Biology (III) Total (I+II+III) EnglishPercentage of Marks secured in Physics, Chemistry, Biology & English in the Qualifying examination.Physics (I) Chemistry (II) Biology (III) Total (I+II+III) EnglishMarks secured in Physics, Chemistry and Biology in the Common Entrance Examination 2012Paper I (Chemistry &Physics) Paper II (Biology) Total (I+II)

KERALA MEDICAL ENTRANCE RANK NO:Hall Ticket No:ADDRESS CORRESPONDENCE PERMANENTHouse No./Name :Village & Post office :City :District :State :Pin code :Telephone No. :Mobile No. :EmailIn case of downloaded application:D.D. No. ..................................................Name of Bank.........................................Date ......................................................... Branch .................................................[Please write your name and the course on the reverse side of the D.D]DECLARATION1. I hereby declare that I am a citizen of India and the particulars given above are correct. In the event, any informationfurnished by me is found to be incorrect or false before or after the selection, the authority conducting the selection cancancel my candidature or admission as the case may be.2. I undertake to submit all the required necessary certificates in original at the time of counseling and during the admissionprocess as per rules, failing which, my claim for selection shall be forfeited by the concerned authority.3. I consent to sign the declaration relating remittance of fee regularly and to obey the rules of institution.Signature of the Parent/GuardianSignature of the ApplicantPlace:Date:Academy of Medical Sciences, Pariyaram, Kannur, Kerala – 670503Phone: 0497-2808111 (15 Lines),0497-2808131, Fax: 0497-2808131web: www.mcpariyaram.com email : acmepariyaram@gmail.com