RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

Rajiv Gandhi University of Health Sciences, Karnataka 4th ‘T’ Block, Jayanagar, Bangalore – 560 041

APPLICATION FOR: (TICK THE APPROPRIATE BOX)

A 1. 2. 5. 6. 7.

8

a.

Eligibility Certificate- Specify the course:

d.

Initial expansion

b.

NOC for Internship Transfer

e.

Migration Certificate

c.

Change of name

f.

Migration Transfer

Name of the candidate in full (in block letters) as registered in SSLC / 10th Examinations. Gender: Male / Female 3. Date of birth: Name of the board from which appeared (10+2)

4. Age:

Name of the College & University from which the Candidate has passed final year Degree exam. Correct postal address to which certificate has to be sent (in block letters with pin code)

Whether the prescribed fee has been remitted? If so furnish details

D.D. No.

Amount:

Bank:

Date:

DOCUMENTS TO BE ENCLOSED A. Eligibility Certificate: (i) U.G.COURSE

1. 2. 3.

SSLC / 10th marks card. 10+2 marks card. Date of birth proof - Transfer certificate

(ii) P.G. Medical /Dental: 1. UG Marks Cards of all Exams. 2. Internship Completion Certificate 3. State Medical / Dental Council Registration Certificate. 4. Provisional / Degree Certificate.

(iii) Super Speciality Courses: 1.P.G. Marks Cards 2. State Medical Council Registration Certificate. 3. P.G.Degree Certificate.

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B. Internship Transfer: 1. No Objection Certificate from both the colleges. 2. Councils provisional registration certificate (MBBS/BAMS/BUMS only). 3. All Degree marks cards. D. Initial expansion:

1. 2. 3. F.

1. 2. 3. 4.

5.

SSLC/10th marks card and 10+2 marks card. Affidavit on stamp paper of Rs.20/- sworn before Notary

C. Change of name: 1. SSLC/10th marks card and 10+2 marks card. 2. Affidavit on stamp paper of Rs.20/- sworn before Notary 3. Paper notification for change of name 4. All Degree marks cards E. Migration Certificate: 1. All Degree marks cards 2. Provisional / Degree Certificate

All Degree marks cards Migration Transfer: No Objection Certificate from both the colleges. Reason for transfer with supporting documents Parent College should issue certificate stating they are not going to fill this vacant seat Transferee College should issue certificate stating they have the vacant seat in particular category. Passed degree marks card/s

Place: Date:

Signature of the candidate

Instructions to the applicant: 1. All payments shall be made in favour of Registrar, RGUHS, Bangalore. 2. Duly filled application form and attested documents will only be considered. (Incomplete application will be rejected) 3. For Change of name and Initial expansion application forwarded by the Principal will only be considered. 4. Prescribed fees for all other above certificates & UG eligibility certificate is Rs.2000/- (Rupees two thousand only). PG eligibility certificate is Rs.3000/- (Rupees three thousand only) 5. All the students who have passed qualifying examination other than the PUC Examination conducted by the Pre University Examination Board of Karnataka shall obtain Eligibility Certificate from Rajiv Gandhi University of Health Sciences before seeking admission to any Health Science Course in the colleges affiliated to this University and produce the same to the Principal concerned. 6. The documents like Marks Sheets, Transfer Certificates, Degree / Diploma Certificates, Date of Birth etc., which are in the languages other than English shall be translated into English and certified by a competent authority, shall be furnished to the University to consider the eligibility. 7. If found ineligible after processing the application, 2/3rd of eligibility certificate fee will be refunded to the candidate. 8. The eligibility certificate shall be obtained separately for each course. 9. The eligibility certificate issued to the candidate will be valid only for the academic year concerned. The eligibility certificate shall be renewed for another academic year on payment of renewal fee of Rs.1500/- for PG and Rs.1000/for UG respectively. 10. The migration transfer certificate will be issued as per rules governing migration transfer in different faculties. 11. This application is not for NRI/SAARC/Foreign Candidates