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Information Brochure: Admission to MBBS course under the Management Quota for th e Academic year 2013-14 GSL Medical

College, Rajahmundry Rules and Regulations Introduction: The provisions contained in this set of regu lations govern the policies and procedures on the admission of students, imparti ng instructions of courses, conducting examinations and evaluation, and certific ation of students performance leading to the MBBS degree. This set of regulations , shall be in addition to NTR University of Health Sciences stipulated regulatio ns with all the amendments thereto, and shall be binding on all students undergo ing the Under Graduate programs. In order to guarantee fairness and justice to a ll the parties concerned, any specific issues or matters of concern shall be add ressed separately, by the appropriate authorities, as and when found necessary. Application form and the information brochure will be available for sale @ Rs.50 00/ per copy in the Office of the Principal, GSL Medical College, Rajahmundry fr om 0900 h on 11 Jul 2013 to 1600 h on 18Jul 2013. 1. The candidates seeking admi ssion to MBBS course are required to:1. Go through Information Brochure carefull y and acquaint themselves with all the rules, regulations and requirements for a dmission to MBBS course under the management quota. 2. Acquaint themselves with eligibility conditions/criteria prescribed for admission. 3. Send application du ly filled in the prescribed form, given along with this Information Brochure. Ea ch application form is allotted a serial number. Application submitted on a phot ocopy of application form will be summarily rejected. 4. Candidates seeking admi ssion to seats under Management Quota General (C1 Category) and candidates seeki ng admission to seats under Management Quota - NRI (C2 category) should apply on separate application forms specifically meant for them. 5. Write complete addre ss with Postal Pin Code, Telephone No., Mobile No., Email address if any, in App lication Form. The candidate is required to mention in the postal address the di strict to which he / she belong. 5. The candidates applying for admission, if fo und eligible, will be required to appear before Selection /Counseling Board for interview at their own expenses at GSL Medical College, Rajahmundry on a date an d time fixed by the college. 6. Selection of candidates in all the categories sh all be subject to production and verification of all the relevant certificates i n original.

7. The counseling results will be available in the offices of the Principal, GSL Medical College, Rajahmundry for information and perusal of the candidates. The result will also be available on the website (www.gslmc.com) and Notice Board o f the college. 8. The Selection Board shall have the power to review the provisi onal selection in case of any bonafide error or lapse or mistake or fraud, misre presentation or glaring injustice that occurs or is brought to its notice before completion of the selection process or after the selection / admission process and the selection list shall be amended accordingly. Mere figuring in the select ion list will not confer any right to admission on the candidate if he / she is otherwise found ineligible on detection of such error / mistake / fraud / misrep resentation/ impersonation etc. 9. Any attempt by the candidate to secure admiss ion through agents, by proxy and misrepresentation will automatically render him /her ineligible for admission. 2. Availability of Seats: Management Quota Genera l seats: 37 Management Quota NRI seats: 23 3. Eligibility: Educational Qualifica tions: The candidates should have passed two years Intermediate (10+2 pattern) o r equivalent examination with Physics, Chemistry, Botany, Zoology and English in dividually and must have obtained not less than 50% marks taken together in Phys ics, Chemistry, Botany and Zoology. In respect of candidates belonging to Schedu led Caste and Scheduled Tribes and the Backward Classes the marks obtained shall be a minimum of 40% marks taken together in Physics, Chemistry, Botany and Zool ogy. OC-PH candidates shall must have obtained not less than 45% marks taken tog ether in Physics, Chemistry, Botany and Zoology. Age : Minimum age: Should have completed the age of 17 years by 31st December, 2 013. In addition, all candidates are directed to refer to MCI Regulations for Graduat e Medical Education, 1997 and NTR University of Health Sciences regulations, ame nded from time to time for eligibility and other purposes. 4. Certificates to be attached Attested Photostat copies of the following certif icates should be attached with the filled up application form strictly in the or der given below. a) Certified copy of the SSC or any equivalent examination showing date of birth and other particulars of the candidate. b) Certified copy of Memorandum of Mark s of the qualifying examination making eligible for admission. c) Study & Conduct Certificate.

d) Transfer Certificate from Board of Intermediate Education E) Migration Certif icate (If applicable) F) Equivalence Certificate (if applicable) G) Passport Siz e Photographs 8 Nos. 5. How to Submit (i) Filled in application form, complete i n all respects, shall be submitted personally at the office of Principal, GSL Me dical College, NH-16, Lakshmipuram, Rajahmundry 533 296 from 9 AM to 4 PM agains t receipt (Acknowledgement Card) on or before the last date fixed for receipt of applications. (ii). Application Forms received before 11 Jul 2013 and after 18 Jul 2013 by whatever mode, including personal submission, registered post and sp eed post will neither be entertained nor will those forms be returned to the con cerned candidates. 6. BONDS Bonds listed hereunder should be submitted in origin al at the time of Interview. The format of the bonds is given in annexure II to IV. 1. Bank guarantees 2. Study bond to NTRUHS 3. Service bond to Government 4. Code of Conduct & Anti-ragging affidavit 7. Selection Criteria for admission: 1. Candidates for MBBS course shall be sele cted strictly on the basis of their academic merit. 2. For determining the acade mic merit, a) The marks obtained in Physics, Chemistry, Botany and Zoology in the qualifyin g examination shall be reckoned. a) In case of a tie, the older candidate shall be given the higher place in the merit list. 8. Selection Procedure: 1. The College office will scrutinize all applications r eceived and registered on or before the time & date set for submitting the appli cations and prepare the merit list of candidates on the basis of individuals mark s obtained in Physics, Chemistry, Botany and Zoology in the qualifying examination. Merit list containing the names of the candidates as per the order of merit will be prepared and displayed on the notice board and website of the c ollege. Separate merit list will be made for Management Quota General Seats (C1) and Management Quota NRI seats (C2). 2. The candidates whose names appear in th e merit list referred to above shall appear before the Interview/Counselling Boa rd on a date and time fixed by the college. The date and

time for interview/counselling will be displayed on the website and notice board of the college. The candidate should physically attend the interview. No proxy will be entertained. 3. Candidates called for counselling/interview shall submit all original certificates, Bank guarantee, bonds, college tuition fee (by deman d draft payable to the Principal, GSL Medical College, Rajahmundry) to the colle ge office three hours before the interview time. Only those candidates who have submitted original documents, bonds, bank guarantee and tuition fee will be elig ible to appear before the interview/counselling board. 4. The college interview/ counselling board will scrutinize the applications and the documents submitted b y the candidates and determine the inter se merit of the candidate. 5. Final lis t of candidates selected for admission under management quota will be prepared a nd displayed on the website and notice board of the college. A final merit list thus prepared will be sent to Dr NTR University of Health Sciences for approval. 6. Candidates who have applied for admission under management quota and have an y grievance regarding the admission process may approach the principal, GSL Medi cal college within 24 h of displaying the merit list. 7. The college will admit candidates from the merit list approved by Dr NTR University of Health Sciences. 9. Joining Time: The selected candidates shall join the college within the specified date. If any candidate fails to report to the Principal on or before the date specified by t he college authority at the time of counselling the admission granted shall be c ancelled automatically without any further notice and no further claims will be entertained under any circumstances. The candidate will forfeit the tuition fee paid to the college for the academic year 2013-14. 10. General Information: One year Compulsory Rural Service: As per G.O.Ms. No. 166, HM & FW (E1) Dept., dated 20.07.2010.The Compulsory Rural Medical/ dental service for MBBS/ BDS candidate s admitted from the academic year 2010-11 onwards shall be for a period of one y ear, immediately following the successful completion of the MBBS/BDS including t he completion of house surgency. The candidates shall be called as junior reside nt during the period of one year of rural service. On successful completion of t he one year rural Medical Service, the candidate will be eligible for a permanen t registration with AP Medical Council. Attendance 1. Head of the Departments shall maintain attendance record of MBBS s tudents in their respective disciplines. He/She will finalize the attendance wit hin three calendar days after the last instructional day of the course in the se mester. Attendance for theory and clinics/practical will be maintained separatel y.

2. A student whose attendance is less than 80% of the classes conducted in the c ourse is not eligible to appear for the End Semester Examination (Internal Asses sment) for that course. 3. The details of all students who have less than 80% at tendance in a course will be notified to the Principal before the commencement o f the end semester examination by respective department. Vacation: The vacation for the students is 30 days per academic year. The vacation will be declared by the Principal in phased manner at the discretion of the Principal t aking into consideration two weeks of summer vacation and remaining period for r eligious festivals. Residency: GSL Medical College management prefers all their students to live in the hostels in the campus to facilitate attending classes/clinics at short notic e and improve professional skills. Discipline: Discipline, Code of conduct, anti -ragging regulations and MCI Code of medical ethics regulations will be supplied to the candidate on a CD at the time of interview/Counseling. It is mandatory t o sign affidavit of anti-ragging and code of conduct before appearing for the in terview.

Annexure I DECLARATION OF THE STUDENT I hereby solemnly and sincerely affirm that the statement made and information f urnished by me in the application form and also in all the enclosures there to s ubmitted by me are true and correct. I have not kept any information secret. Sho uld it however be found that any information furnished therein is fraudulent, in correct or untrue in material particulars at any time during the pursuit of the course, I realize my selection or admission to the course is liable to be cancel led and I am liable for criminal prosecution. Further I also agree to forego my seat and fees paid thereof in GSL Medical College, Rajahmundry, unconditionally and I will not move any court of law in this connection. I am also fully aware t hat I may not be permitted to appear for any University Examinations unless I sh ow required percentage of attendance to theory and practical classes and perform ance in Internal Assessment Examination in concerned subjects in fulfillment of regulations laid down by Medical Council of India and Dr.NTR University of Healt h Sciences. I shall abide by the decision of the selection Committee / Principal , GSL Medical College, Rajahmundry, which shall be final and binding on me. Sign ature of the Applicant. Declaration by the Parent/Guardian I have fully read the information furnished by my son / daughter / ward in his/h er application for admission to I MBBS Course in GSL Medical College, Rajhmundry and affirm that the information furnished is true to the best of my knowledge. Should it however be found that any information furnished therein is fraudulent, incorrect or untrue in material particulars at any time during the pursuit of t he course and if it is proved that the information was fraudulent, I am liable f or criminal prosecution and also forfeit the seat allotted to my ward and fees p aid there of and abide by other conditions as specified above. OFFICIAL ADDRESS : RESIDENTIAL ADDRESS : Date : SIGNATURE OF THE PARENT / GUARDIAN

Annexure II SERVICE BOND (Non-Judicial stamped paper for Rs.100-00) N.B.: 1. The bond format shall be typed on the Non Judicial stamped paper. 2. Sureties shoul d be of two permanent Gazetted Officers of Andhra Pradesh Government. I, Mr./Ms. ______________________________________ selected for MBBS/BDS course ____________ ________________for the year 2013-14 do hereby undertake, as per G.O.Ms. No. 166, HM & FW (E1) Dept., dated 20.07.2010 to provide Compulsory Rural Medical/ dental service for a period of one year, immediately following th e successful completion of the MBBS/BDS including the completion of house surgen cy. Date : Witness : 1. Signature : Name and Address in full 2. Signature : Name and Address in full Signature of the Candidate Sureties 1.Signature : Name and Address in full 2.Sig nature : Name and Address in full (Annexure III) STUDY BOND (Non-Judicial stamped paper for Rs.100-00) For all can didates N.B.: 1. The bond format shall be typed on the Non Judicial stamped pape r. 2. Sureties should be of two permanent Gazetted Officers of Andhra Praesh Gov ernment. I, Dr.___________________________________ selected for MBBS/BDS________ __________________ for the year 2013-14 do hereby undertake to complete the said course as per the requirements of the University. In the event of my leaving th e studies after joining the course, I undertake to pay to the Dr. N.T.R. Univers ity of Health Sciences a sum of Rs.50,000-00 (Rupees fifty Thousand Only) and re fund the amount received as stipend up to that date to Government. Date : Signat ure of the Candidate Witness : Signature : Name and Address in full 2. Signature : Name and Address in full Sureties 1.Signature : Name and Address in full 2.Si gnature : Name and Address in full 1.

(Annexure IV) IRREVOCABLE BANK GUARANTEE (for Undergraduate Degree MBBS / BDS) W e, . Bank, having its Branch at . (hereinafter to be the request, upon application and on behalf of Mr. / Ms. .., S/o. / D/o. T) in favour GSL Educational Society, represented by its Secretary, GSL Medical C ollege, NH-16, Lakshmipuram, Rajahmundry-533296, Andhra Pradesh (hereinafter to be referred as BENEFICIARY) WHEREAS the above named student got admitted into MBBS /BDS course with the for the academic year 2013-14 for the duration of full cour se of five years in the Beneficiary Institute and paid the 1st year fee of Rs.5, 50,000/- and is also obligated to pay the balance fee of Rs.22,00,000/- for the remaining 2nd , 3rd 4th and 5th year period of course. WHEREAS as per the condit ions for admission and Rules governed there under, the Student is required to fu rnish an Irrevocable Bank Guarantee to the Beneficiary from any Nationalized Ban k to protect the interest of the Beneficiary in the event of any default of the Student in payment of balance fee during the entire course. Hence, in the event of default on the p art of the student in payment of balance fee of rs.22,00,000 /- or any part thereof during the balance course period, the Bank on behalf of t he student thereby irrevocably, unequivocally and unconditionally agrees and und ertakes to pay forthwith the said sun of Rs.22,00,000/- or part thereof the Bene ficiary without any condition, protest demur or proof and without reference to t he student and irrespective of and not withstanding any contest / objection from the student or the existence of any dispute between the student and the benefic iary upon the beneficiary invoking this Bank Guarantee with the letter of Invoca tion by surrendering this Original Bank Guarantee to the Bank. The Bank agrees t o make the payment of invoked amount to the Beneficiary simultaneously on the Be neficiary submitting the Letter of Invocation along with Original Bank Guarantee . The Bank further agrees that this Guarantee shall constitute an independent an d autonomous contact between the Bank and the Beneficiary and shall not in any w ay be affected by any dispute or difference between you viz., the Beneficiary an d the student of whatsoever nature. Finally, the Bank confirms that a mere lette r from the Beneficiary that there has been a default on the part of the Student in payment of the fees, shall without any other or further proof be final, concl usive and binding on the Bank to treat the same as a valid invocation and for ma king the simultaneous payment of the demanded amount upto the maximum of rs.22,0 0,000/-. This Bank Guarantee shall remain in force up to 31.08.2017 and all clai ms should be received by the Bank on or before the said date.

DECLARATION OF THE STUDENT AND PARENT / GUARDIAN I hereby solemnly and sincerely affirm that the statement made and information furnished by me in the applicati on form and also in all the enclosures there to, are true and correct. I have ne ither withheld any information nor furnished fraudulent information. Should it h owever be found that any information furnished therein is fraudulent, incorrect or untrue in material particulars at any time during the pursuit of the course, I realize my selection or admission to the course is liable to be cancelled and I am liable for criminal prosecution. Further I also agree to forego my seat and fees paid thereof to GSL Medical College, Rajahmundry, unconditionally and I wi ll not move any court of law in this connection. I have read MBBS course brief r egulations of MCI / Dr.NTR University of Health Sciences. I am aware that I may not be permitted to appear for any University Examinations unless I have 7 5% attendance in theory and practical/Clinics separately, and score minimum 35% marks in Internal Assessment Examination in concerned subjects in fulfillment of regulations laid down by Medical Council of India and Dr.NTR University of Heal th Sciences. Cont2

I shall abide by the decision of the selection Committee / Principal, GSL Medica l College, Rajahmundry, which shall be final and binding on me. Date: SIGNATURE OF THE APPLICANT I have fully read the information furnished by my son / daughter / ward and affi rm that it is true and if it is proved that the information was fraudulent, I am liable for criminal prosecution and also forfeit the seat allotted to my ward a nd fees paid there of and abide by other conditions as specified above. OFFICIAL ADDRESS : . . RESIDENTIAL ADDRESS : Date : SIGNATURE OF THE PARENT / GUARDIAN Cont3

DISCIPLINARY DECLARATION I __________________________________________________________________________ S/o / D/o.___________________________________________________________________ re sident of __________________________________________________ I MBBS, during the academic year _______________ provisionally selected for Admission into at GSL Medical College, Rajahmundry, do hereby solemnly affirm and state that I undertake to abide by all rules and regulations of GSL Medical College that are already in Vogue and that may come into force f rom time to time. I further undertake to make good any loss sustained by GSL Medical College, Raja hmundry due to my negligence. I am aware that any involvement in any manner in t he acts that break or contravene the rules & regulations of GSL Medical College attract punishment / disciplinary action. I further agree that any disputes between the Management / Administration and st udents are subject to the Jurisdiction of Courts at Rajahmundry only and the jur isdiction of all other courts are hereby excluded. Date: Signature of the Candidate I, _________________________________________________________Parent / Guardian of Mr. / Ms._________________________________________________ undertake to see that my ward Mr. / Ms. _________________________________________________________abid es by all the rules & regulations of GSL Medical College, as per the above decla ration. Date: Signature of the Parent / Guardian (Relationship to be mentioned) Cont4

FORMAT OF UNDERTAKING IN REGARDS FOR THE FEES FROM: 1. PARENT/GUARDIAN Name & Ad dress 2. STUDENT Name & Address Date: To, The Principal, GSL Medical College, NH - 16, Lakshmipuram. Rajahmundry - 533296 Sub: Undertaking in regard for the fee s to be paid to the college Dear Sir, (1) I, Mr/Ms._____________________________ ___________________(Name of the student) residing at____________________________ _______________________. (2) We, Mr./Ms.________________________________________ __ (Name of the Parent/Guardian) residing at ___________________________________________the former having been ad mitted to the MBBS course at your institute under Convener/Management seat quota (Cat A, Cat B, Cat C) hereby agree, affirm and declare jointly and severally th at we shall abide to pay the yearly tuition fees of Rs.50,000/ Rs.2,50,000/ Rs.5 ,50,000/ for five academic years to the said Institute as specified by the insti tute and the said fee shall be neither negotiable nor refundable in full or part thereof under any circumstances and that we will not raise the issue of refundi ng to us the said amount at any time or under any circumstance. We also agree an d undertake to pay the prescribed fee for each term if the period of study is pr olonged beyond the normal prescribed period of four and a half years of study du e to any reason whatsoever. We also understand that if all the dues are not clea red, the student may not be allowed to appear for the university examination. We further agree and declare that In the event of his / her seat falling vacant du e to discontinuation of the course in the middle or any other reason we shall ab ide to pay the tuition fee and other fees for the remaining years of study as ma y be due on the date of discontinuation to GSL Medical College, Rajahmundry, in lump sum. Yours faithfully, STUDENT PARENT Cont5

ANNEXURE I AFFIDAVIT BY THE STUDENT I, _________________________________________ ______________(full name of student with University Roll Number) s/o d/o Mr./Mrs ./Ms. ___________________________________, having been admitted to _____________ ________________(name of the institution), have received a copy of the UGC Regul ations on Curbing the Menace of Ragging in Higher Educational Institutions, 2009 , (hereinafter called the Regulations) carefully read and fully understood the pro visions contained in the said Regulations. 2) 3) I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes ragging. I have also, in particular, perused clause 7 and clause 9.1 of the Regulations and am f ully aware of the penal and administrative action that is liable to be taken aga inst me in case I am found guilty of or abetting ragging, actively or passively, or being part of a conspiracy to promote ragging. 4) I hereby solemnly aver and undertake that a) I will not indulge in any behavior or act that may be constit uted as ragging under clause 3 of the Regulations. b) I will not participate in or abet or propagate through any act of commission or omission that may be const ituted as ragging under clause 3 of the Regulations. 5) I hereby affirm that, if found guilty of ragging, I am liable for punishment according to clause 9.1 of the Regulations, without prejudice to any other criminal action that may be take n against me under any penal law or any law for the time being in force. 6) I he reby declare that I have not been expelled or debarred from admission in any ins titution in the country on account of being found guilty of, abetting or being p art of a conspiracy to promote, ragging; and further affirm that, in case the de claration is found to be untrue, I am aware that my admission is liable to be ca ncelled. Declared this ____day of _________ month of ______year. _______________________ Signature of deponent Name: Cont6

ANNEXURE II AFFIDAVIT BY PARENT/GUARDIAN I, Mr./Mrs./Ms. ____________________________________________________(full Name o f parent / guardian) father/mother/guardian of ,________________________________ ________ (full name of student with University Roll Number), having been admitte d to _______________________________(name of the institution), have received a c opy of the UGC Regulations on Curbing the Menace of Ragging in Higher Educationa l Institutions, 2009, (hereinafter called the Regulations), carefully read and ful ly understood the provisions contained in the said Regulations. 2) 3) I have, in particular, perused clause 3 of the Regulations and am aware as to what constit utes ragging. I have also, in particular, perused clause 7 and clause 9.1 of the Regulations and am fully aware of the penal and administrative action that is l iable to be taken against my ward in case he/she is found guilty of or abetting ragging, actively or passively, or being part of a conspiracy to promote ragging . 4) I hereby solemnly aver and undertake that a) My ward will not indulge in an y behavior or act that may be constituted as ragging under clause 3 of the Regul ations. b) My ward will not participate in or abet or propagate through any act of commission or omission that may be constituted as ragging under clause 3 of t he Regulations. 5) I hereby affirm that, if found guilty of ragging, my ward is liable for punishment according to clause 9.1 of the Regulations, without prejud ice to any other criminal action that may be taken against my ward under any pen al law or any law for the time being in force. 6) I hereby declare that my ward has not been expelled or debarred from admission in any institution in the count ry on account of being found guilty of, abetting or being part of a conspiracy t o promote, ragging; and further affirm that, in case the declaration is found to be untrue, the admission of my ward is liable to be cancelled. Declared this ______day of ________________ month of ________year. _____________________________ Signature of deponent Name: Address: Telephone / M obile No.: The above declarations duly notarized by me. Mr./Ms.____________________________________________________Notary Public. Place: __________________ Date: __________________ Seal/Stamp of Signature of the Notar y Public Notary Public

NH-16, Lakshmipuram, Rajahmundry-533296, A.P. Tel. No.:0883-2484999; Fax : 08832483023 Recognized by M CI / Govt. of India vide Lr.No.U12012/76/2002-M E(P-II), dt:03.02.2010. Affiliated to Dr.NTR University of Health Sciences, Vijayawada GSL Medical College APPLICATION FOR ADMISSION INTO I YEAR MBBS COURSE 2013 2014. Management Quota C1 Category Application No.: Registration No.: Date:..

SUMMARY (TO BE FILLED IN BY THE CANDIDATE IN HIS / HER OWN HAND WRITING) 1. Full Name & Address : ..... ...... .... A B SC C D OT H ERS Male Month Months Female Year Days : Years ST BC A B C D E 6. Qualifying Examination : INTERMEDIATE 10+2 COURSE Equivalent Exam (Specify) 7. Year of Passing the Qualifying Examination 8. Qualifying Examination-Sciences Total Marks (Botany/Zoology/Physics/Chemistry) 9. No. of Enclosures : Obtained Max-Marks : :.. Mark in appropriate space under 2, 5 & 6 SIGNATURE OF THE CANDIDATE Remarks FOR OFFICE USE ONLY Academic Officer I/C Checked by:

NH-16, Lakshmipuram, Rajahmundry-533296, A.P. Tel. No.:0883-2484999; Fax : 08832483023 Recognized by M CI / Govt. of India vide Lr.No.U12012/76/2002-M E(P-II), dt:03.02.2010. Affiliated to Dr.NTR University of Health Sciences, Vijayawada. GSL Medical College APPLICATION FOR ADMISSION INTO I YEAR MBBS COURSE 2013 2014. Under Management Quota C1 Category Date:.. Application No.: Registration No.: Total No. of enclosures ( ) Read the Regulations carefully before filling up of the application: NOTE: Passport size photo attested by Gazetted Officer / Principal of concerned colleg e where applicant studied last a) Filled application forms shall be submitted in person to the Admission Cell, Office of the Principal, GSL Medical College, NH 16, Lakshmipuram, Rajahmundry. 533 296, Andhra Pradesh on or before 1600 hr on -- Jul 2014. b) Applications una ccompanied by required certificates or applications with incomplete entries and ineligible applications shall stand rejected automatically. Please do not leave any column blank. Where information is NIL write NO / NIL. c) Applications of th e candidates who furnish incorrect information, enclose false / incorrect certif icate or approach through agents shall stand rejected automatically. d) Applicat ion shall be filled in English by the candidate in his / her own handwriting. e) No enclosures will be accepted after submission of application form. f) The cov er must be super scribed For Admission into I year MBBS course 2013 - 2014.

1. Full Name : (IN BLOCK LETTERS AS ENTERED IN INTERMEDIATE OR EQUIVALE Female 3. a) Name of the Father / Mother : b) Name of the Guardian, if ent / guardian : 5. Date of Birth as entered in SSC or equivalent : t December, 2013 : 7. Address (Complete Postal Address) i. D/o. / S/o. / Town / City District / State Pin Code Phone No with STD Code iii. Road / Street 8. Place of Birth :

9. Mother Tongue 10. a) Nationality and Religion b) Native District and State : : : Qualifying Exam Date 11. EDUCATIONAL QUALIFICATIONS Particulars of Qualifying examinations i. Name of Qualifying Examination (Indicate the month and year of Appearance) ii. H.T.No., Subjects, Class or Division in Examination Hall Ticket No. Division / Class Opt ional Subjects : : : H.T.No. Rank Total Marks 12. a) I) EAMCET-2013 Particulars (If appeared) 13. Total Marks obtained in Scie nce subjects in the Intermediate or its equivalent examination: Botany Marks obtained Maximum Marks % up to Two decimal place Zoology Physics Chemistry Total 14. Any other particulars the candidate desires to furnish : DOCUMENTS TO BE SUBMITTED ALONG WITH THE APPLICATION: 1. Certified copy of the S SC or any equivalent examination showing date of birth and other particulars of the candidate. 2. Certified copy of Memorandum of Marks of the qualifying examin ation making eligible for admission. 3. Study & Conduct Certificate. 4. Transfer Certificate from Board of Intermedia te Education 5. Migration Certificate (If applicable) 6. Equivalence Certificate (if applicable) 7. Passport Size Photographs 8 Nos 8. 9. Photocopy of the Bank Guarantee Photocopy of Study bond XEROX COPIES OF THE CERTIFICATES MUST BE ATTESTED BY GAZETTED OFFICER -------------------------------------------------------------------------------------------------

DECLARATION OF THE STUDENT AND PARENT / GUARDIAN I hereby solemnly and sincerely affirm that the statement made and information f urnished by me in the application form and also in all the enclosures there to s ubmitted by me are true and correct. I have not kept any information secret. Sho uld it however be found that any information furnished therein is fraudulent, in correct or untrue in material particulars at any time during the pursuit of the course, I realize my selection or admission to the course is liable to be cancel led and I am liable for criminal prosecution. Further I also agree to forego my seat and fees paid thereof in GSL Medical College, Rajahmundry, unconditionally and I will not move any court of law in this connection. I am also fully aware t hat I may not be permitted to appear for any University Examinations unless I sh ow required percentage of attendance to theory and practical classes and perform ance in Internal Assessment Examination in concerned subjects in fulfillment of regulations laid down by Medical Council of India and Dr.NTR University of Healt h Sciences. I shall abide by the decision of the selection Committee / Principal , GSL Medical College, Rajahmundry, which shall be final and binding on me. Date : SIGNATURE OF THE APPLICANT

Declaration by the Parent/Guardian I have fully read the information furnished by my son / daughter / ward in his/h er application for admission to I MBBS Course in GSL Medical College, Rajhmundry and affirm that the information furnished is true to the best of my knowledge. Should it however be found that any information furnished therein is fraudulent, incorrect or untrue in material particulars at any time during the pursuit of t he course and if it is proved that the information was fraudulent, I am liable f or criminal prosecution and also forfeit the seat allotted to my ward and fees p aid there of and abide by other conditions as specified above. OFFICIAL ADDRESS : RESIDENTIAL ADDRESS : Note : No application will be deemed complete unless this declaration is signed by the candidate / parent / guardian (If parent not alive) ANTI-RAGGING DECLARATION We hereby declare that the candidate will not indulge in any act of Ragging in t erms of the Act and ruling by Supreme Court of India during the course of study in this institute. We fully understand that such involvement may lead to not onl y forfeiture of the seat & payments made but also to fine or and imprisonment as per provisions of the law. Sign. of the Candidate Date : Sign. of the Parent / Guardian Date :

ACKNOWLEDGEMENT CARD Regn. No. received application form from To Mr./Ms.. for admission ____ on dt: . . . Note: 1. Write your address on the Acknowledgement card. 2. Quote the Regn. No. in future correspondence.

ACKNOWLEDGEMENT CARD Regn. No. received application form from To Mr./Ms.. for admission ____ on dt: . . . Note: 1. Write your address on the Acknowledgement card. 2. Quote the Regn. No. in future correspondence.

ACKNOWLEDGEMENT CARD Regn. No. received application form from To Mr./Ms.. for admission ____ on dt: . . . Note: 1. Write your address on the Acknowledgement card. 2. Quote the Regn. No. in future correspondence.

NH-16, Lakshmipuram, Rajahmundry-533296, A.P. Tel. No.:0883-2484999; Fax : 08832483023 Recognized by M CI / Govt. of India vide Lr.No.U12012/76/2002-M E(P-II), dt:03.02.2010. Affiliated to Dr.NTR University of Health Sciences, Vijayawada GSL Medical College APPLICATION FOR ADMISSION INTO I YEAR MBBS COURSE 2013 2014. Management Quota C2 Category Application No.: Registration No.: Date:..

SUMMARY (TO BE FILLED IN BY THE CANDIDATE IN HIS / HER OWN HAND WRITING) 1. Full Name & Address : ..... ...... .... A B SC C D OT H ERS Male Month Months Female Year Days : Years ST BC A B C D E 6. Qualifying Examination : INTERMEDIATE 10+2 COURSE Equivalent Exam (Specify) 7. Year of Passing the Qualifying Examination 8. Qualifying Examination-Sciences Total Marks (Botany/Zoology/Physics/Chemistry) 9. No. of Enclosures : Obtained Max-Marks : :.. Mark in appropriate space under 2, 5 & 6 SIGNATURE OF THE CANDIDATE Remarks FOR OFFICE USE ONLY Academic Officer I/C Checked by:

NH-16, Lakshmipuram, Rajahmundry-533296, A.P. Tel. No.:0883-2484999; Fax : 08832483023 Recognized by M CI / Govt. of India vide Lr.No.U12012/76/2002-M E(P-II), dt:03.02.2010. Affiliated to Dr.NTR University of Health Sciences, Vijayawada. GSL Medical College APPLICATION FOR ADMISSION INTO I YEAR MBBS COURSE 2013 2014. Under Management Quota C2 Category Date:.. Application No.: Registration No.: Total No. of enclosures ( ) Read the Regulations carefully before filling up of the application: NOTE: Passport size photo attested by Gazetted Officer / Principal of concerned colleg e where applicant studied last

a) Filled application forms shall be submitted in person to Admission Cell, Offi ce of the Principal, GSL Medical College, NH 16, Lakshmipuram, Rajahmundry. 533 296, Andhra Pradesh on or before 1600 hr on -- Jul 2014. b) Applications unaccom panied by required certificates or applications with incomplete entries and inel igible applications shall stand rejected automatically. Please do not leave any column blank. Where information is NIL write NO / NIL. c) Applications of the ca ndidates who furnish incorrect information, enclose false / incorrect certificat e or approach through agents shall stand rejected automatically. d) Application shall be filled in English by the candidate in his / her own handwriting. e) No enclosures will be accepted after submission of application form. f) The cover m ust be super scribed For Admission into I year MBBS course 2013 - 2014. g) Affidav it signed by NRI student in the format given in the brochure 1. Full Name : ERED IN INTERMEDIATE OR EQUIVALENT CERTIFICATE) 2. Sex : Male Female 3. a) Name of the Father / Mother : b) Name of the Guardian, if parents are not al tered in SSC or equivalent : Examination (Proof to be submitted) 6. Age Postal Address) i. D/o. / S/o. / C/o. : . ii. iv. v. vi. vii. D.No. ict / State Pin Code Phone No with STD Code iii. Road / Street .. : 8. Place of Birth :

9. Mother Tongue 10. a) Nationality and Religion b) Native District and State : : : Qualifying Exam Date 11. EDUCATIONAL QUALIFICATIONS Particulars of Qualifying examinations i. Name of Qualifying Examination (Indicate the month and year of Appearance) ii. H.T.No., Subjects, Class or Division in Examination Hall Ticket No. Division / Class Opt ional Subjects : : : H.T.No. Rank Total Marks 12. a) I) EAMCET-2013 Particulars (If appeared) 13. Total Marks obtained in Scie nce subjects in the Intermediate or its equivalent examination: Botany Marks obtained Maximum Marks % up to Two decimal place Zoology Physics Chemistry Total 14. Any other particulars the candidate desires to furnish : DOCUMENTS TO BE SUBMITTED ALONG WITH THE APPLICATION: 1. Certified copy of the S SC or any equivalent examination showing date of birth and other particulars of the candidate. 2. Certified copy of Memorandum of Marks of the qualifying examin ation making eligible for admission. 3. Study & Conduct Certificate. 4. Transfer Certificate from Board of Intermedia te Education 5. Migration Certificate (If applicable) 6Equivalence Certificate (if applicable) 7. Passport Size Photographs 8 Nos. 8. Affidavit by the Candidat e stating that he/she is the ward of NRI 9. Photocopy of the Bank Guarantee 10. Photocopy of Study bond XEROX COPIES OF THE CERTIFICATES MUST BE ATTESTED BY GAZETTED OFFICER -------------------------------------------------------------------------------------------------

DECLARATION OF THE STUDENT AND PARENT / GUARDIAN I hereby solemnly and sincerely affirm that the statement made and information f urnished by me in the application form and also in all the enclosures there to s ubmitted by me are true and correct. I have not kept any information secret. Sho uld it however be found that any information furnished therein is fraudulent, in correct or untrue in material particulars at any time during the pursuit of the course, I realize my selection or admission to the course is liable to be cancel led and I am liable for criminal prosecution. Further I also agree to forego my seat and fees paid thereof in GSL Medical College, Rajahmundry, unconditionally and I will not move any court of law in this connection. I am also fully aware t hat I may not be permitted to appear for any University Examinations unless I sh ow required percentage of attendance to theory and practical classes and perform ance in Internal Assessment Examination in concerned subjects in fulfillment of regulations laid down by Medical Council of India and Dr.NTR University of Healt h Sciences. I shall abide by the decision of the selection Committee / Principal , GSL Medical College, Rajahmundry, which shall be final and binding on me. Date : SIGNATURE OF THE APPLICANT

Declaration by the Parent/Guardian I have fully read the information furnished by my son / daughter / ward in his/h er application for admission to I MBBS Course in GSL Medical College, Rajhmundry and affirm that the information furnished is true to the best of my knowledge. Should it however be found that any information furnished therein is fraudulent, incorrect or untrue in material particulars at any time during the pursuit of t he course and if it is proved that the information was fraudulent, I am liable f or criminal prosecution and also forfeit the seat allotted to my ward and fees p aid there of and abide by other conditions as specified above. OFFICIAL ADDRESS : RESIDENTIAL ADDRESS : Note : No application will be deemed complete unless this declaration is signed by the candidate / parent / guardian (If parent not alive) ANTI-RAGGING DECLARATION We hereby declare that the candidate will not indulge in any act of Ragging in t erms of the Act and ruling by Supreme Court of India during the course of study in this institute. We fully understand that such involvement may lead to not onl y forfeiture of the seat & payments made but also to fine or and imprisonment as per provisions of the law. Sign. of the Candidate Date : Sign. of the Parent / Guardian Date :

ACKNOWLEDGEMENT CARD Regn. No. received application form from To Mr./Ms.. for admission ____ on dt: . . . Note: 1. Write your address on the Acknowledgement card. 2. Quote the Regn. No. in future correspondence.

ACKNOWLEDGEMENT CARD Regn. No. received application form from To Mr./Ms.. for admission ____ on dt: . . . Note: 1. Write your address on the Acknowledgement card. 2. Quote the Regn. No. in future correspondence.

ACKNOWLEDGEMENT CARD Regn. No. received application form from To Mr./Ms.. for admission ____ on dt: . . . Note: 1. Write your address on the Acknowledgement card. 2. Quote the Regn. No. in future correspondence.