CHARACTER CERTIFICATE

From the Institution attended last

It is to certify that ______________________________________________________

S/o / D/o _____________________________________________________ who has studied

in this Institution from ____________________ to ____________________ bears a good

moral character. His/her behaviour was good with teachers and students. He/she has neither

displayed persistent violent of or aggressive behaviour nor any desire to harm others.

Name of Institution last attended: _______________________________

Signature of Head of the Institution

with Seal

Date: ______________
 Declaration-1

Format for the Declaration to be filled and signed by the Candidate on a

Non-Judicial Stamp Paper of Rs. 10/- duly attested by the Notary Public

DECLARATION BY CANDIDATE
1. I hereby solemnly and sincerely affirm that the statements made and information given by
me in the application form are true and correct.
2. I agree to abide by the Rules, Regulations and Procedures as contained in the Information
Brochure / Prospectus.
3. At present, I have not taken admission in any Medical Post Graduate (MD/MS) course
during the previous 3 years. I further declare that, if it is proved that I have secured
admission for any of the Medical PG Course earlier / discontinued after taking admission,
my current year's admission shall be cancelled.
4. I agree to submit all the required original certificates at the time of my selection during
admission process as per the rules, failing which my claim for selection shall not be
granted.
5. I have not concealed any material, information, however, if any information submitted
herein is fraudulent, incorrect or untrue, I understand that I am liable to criminal
prosecution and I also agree to forgo my seat in Nims University, Jaipur. I understand that
my selection and admission to the course is also liable to be cancelled.

Date: ______________ (Signature of the Candidate)

Place: ______________ Candidate's Name: _______________________

 Declaration-2

Format for the Declaration to be filled and signed by the Parent/Guardian

of the Applicant on a Non-Judicial Stamp Paper of Rs. 10/- duly attested by
the Notary Public

DECLARATION BY PARENT/GUARDIAN

I ___________________________ (Name), the parent/guardian of the applicant

Mr./Ms. .____________________________________ (Name of applicant) hereby declare

that I am aware of the financial obligations of admissions of my ward to the MD/MS Course

in Nims University, Jaipur. I agree to pay the tuition fee and other fees payable to the

Institution as fixed from time to time as per the rules. I also affirm and endorse the

declaration made above by my ward.

Date: ______________ (Signature of the Parent/Guardian)

Place: ______________ Name of Father/Guardian: _______________________

 Declaration-3

UNDERTAKING BY THE CANDIDATE / STUDENT

Format for the Affidavit to be filled and signed by the Candidate on a Non-
Judicial Stamp Paper of Rs. 10/- duly attested by the Notary Public

AFFIDAVIT
I, __________________________________ son / daughter of Shri ____________________,
aged ______________ resident of ____________________________________________
hereby state that:
1. I have taken admission in MD/MS course in Nims University, Jaipur.
2. I have carefully gone through the explanation and punishments related to ragging defined
in Petition No. 646/98 (Vishva Jagriti V/s Central Government episode) of Supreme
Court, New Delhi and I have also made my parents aware of it.
3. I know that the Supreme Court has banned ragging in the educational institutions.
4. I will not participate in any ragging activity during the tenure of my MD/MS course.
5. In case I am found involved in any ragging activity, I shall be liable to punishment as per
the relevant regulations of the Council and the Act of the Central / State Government.
Date: __________
Place: __________ DEPONENT
VERIFICATION
I, __________________________________ son / daughter of Shri ____________________,
aged ______________ resident of ____________________________________________
hereby declare that the facts mentioned above from point No. 1 to 5 are true and correct to the
best of my understanding, knowledge and belief. So help me God.
Date: __________
Place: __________ DEPONENT
Address: _____________________
_____________________
_____________________

(Verification by the Notary Public)

 Declaration-4

UNDERTAKING BY THE PARENT / GUARDIAN

Format for the Affidavit to be filled and signed by the Parents/Guardians

of the Applicant on a Non-Judicial Stamp Paper of Rs. 10/- duly attested by
the Notary Public

AFFIDAVIT
I, __________________________________ son of Shri ____________________, aged
______________ resident of ____________________________________________ hereby
state that:
1. My son / daughter _______________________________ has taken admission in MD/MS
course in Nims University, Jaipur.
2. I am aware of the explanation and punishment related to ragging defined in Petition No.
646/98 (Vishva Jagriti V/s Central Government episode) of Supreme Court, New Delhi.
3. My son/daughter shall not participate in any ragging activity during the tenure of his/her
MD/MS course.
4. In case my son/daughter participates or is found involved in any ragging activity, he/she
shall be liable to punishment as per the relevant regulations of the Council and the Act of
the Central / State Government.
Date: __________
Place: __________ DEPONENT
VERIFICATION
I, __________________________________ son of Shri ____________________, aged
______________ resident of ____________________________________________ hereby
declare that the facts mentioned above from point No. 1 to 4 are true and correct to the best of
my understanding, knowledge and belief. So help me God.
Date: __________
Place: __________ DEPONENT
Address: _____________________
_____________________
_____________________
(Verification by the Notary Public)
 NIMS UNIVERSITY, JAIPUR
Shobha Nagar, Jaipur-Delhi Highway, Jaipur-303121 (Rajasthan)
Phone: 9116010411, 9116010456; Website: www.nimsuniversity.org

Admission to MD / MS Course Application Form

Session 2016-17 No.
in National Institute of Medical
Sciences & Research

INTERVIEW CALL LETTER

To _______________________

Kindly refer to your application for admission in Post Graduate course for the
academic year 2016-17. In this regard you are requested to appear for an interview before the
Selection Committee on _____________________ at ________________________
You are also requested to bring all the relevant original certificates at the time of the
interview.

Convener (Admissions)

NIMS UNIVERSITY, JAIPUR

Shobha Nagar, Jaipur-Delhi Highway, Jaipur-303121 (Rajasthan)
Phone: 9116010411, 9116010456; Website: www.nimsuniversity.org

Admission to MD / MS Course Application Form

Session 2016-17 No.
in National Institute of Medical
Sciences & Research

ACKNOWLEDGEMENT RECEIPT

RECEIVED application on ____________________ along with the __________ No.

of copies of Certificates from Mr. / Ms. ________________________________________ for
Post Graduate Course.

Deputy Registrar
(To be filled and returned with Application Form)