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" "Gil ; r Application Form for admission inlo

fi'. MD/MS Phase-B, Residency Program March-2020 i;stifitions for Candidates

^s

L Ali Go\t./Autonomous

candidates should

know Deputalion

Rules/Study leave rules

oftheir employet.

2.

^Private candidares are

eligible

to

apply

one year after

withdrawal from

any course (copy

ofwithd;awal leirer

1.

is 10 be enclosed $,i!h the

applicatioO-

Gor1. candidales who ^q,ere

o. deputatiorrstudy

leave

for

any course can nor apply

within

threc

lears.

Candidates

wirh MD/MS,fCPS

degree must be

in

actlvc

ser'ice in

thc respecrive specialty

for

at least thrce tears ^before applying

to

Phase,B sub-speciahy.

To

be

filled in

by the

candidate (in capital l€tters)

s

BSI\4I\4II

(Revenue/Proiect)

Course

Discipline:

BSMMu/lnsritutions

Requisite papersl

.

sSC or equivalqx .ertificate.

.

MDIMSi'FCPS Degree Cerrifl.ate

.

Updated renewed BMDC feman€nt regislration cenifi car wirh endorernen, otpostsraduate desrce.

.

Order of lirst postirS in the.Lovemment service

.

Appoinltoent letler & Ioining repon at the first

.

Last deputarion oider (whcre alplicabte)

.

Updated PDS aor cndie scrvice

.

Oneyear after passing or

vithdrarlal

from

at the itrteryiew

bord

(Please atiach cur€nr ^Sisrature

&

Seal

of

Departmenial

the course

(ifatry).

.

Remarks, Elisible/No,

I

lsible (Tickas aprlicable

Decision ofDepartm€ntal

Selecfion

Board a{ler interviel

of a

canrliilate

Decision

ofDepsrtm€ntal

Selection

Bosrd after intervi€w ofs candidrte

Selccted

Not

Selecied

(Tick ifselected and

cross

ifnot

selected

io

above

box)

\4ember-Srcretar!

\.fember

Member

Chairmtur/H$d

of _Depr.

[SiCn,nrrr ot ^the Membch $rth olficr0t jert)

Recommendation

Dean Respective Facult]'.

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A/C Examinatiotr

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registration certificate

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endorsement of postgraduate degree.

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