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'

Note:The Undertaking is to be submitted at the time of joining the Medical College to the
Dean of respective Government Medical College to which the candidate has been admitted in
the academic year 20 -20 as per Government of Gujarat Heath and Family Welfare
Department Gandhinagar Resolution NO.MCG/1019/1643/J, dated .....................
(Make it on Rupees 300 /-stamp paper)

UNDERTAKING

Name of Student:
- - - - - - - - - - - - - -·Admission Year: 20 -20

Name of the College: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Form of the bond to be executed for the purpose of one year service to the
government after completion of Post Graduate Diploma or Degree course by a student
admitted to the Post Graduate Diploma or Degree course with two Sureties.
I Dean, Medical College, . Informed to student
and father and guardian of student: - - - - - - - - - - - - - - - - - -
Jointly and each of us severally held and firmly bound by the Governor of Gujarat
exercising the executive (hereinafter called "the government"), in the sum of
Rs.30,00,000/- (Rupees Thirty Lakhs Only) to be paid to the government on demand
from the date of demand till payment for which payment well and truly to be made. I
DO HEREBY JOINTLY and each of us severally firmly bind ourselves, our sureties, our
respective heirs, executors, administrators and legal representative by these presents.
Signed this day of whereas the Government Medical College in the
state for the Post Graduate Diploma or Degree course. ( i ) Every student should
admitted shall complete the said Course from the college to which he/she is admitted or
from any other Government Medical College and recognized Private Medical College in
the state of Gujarat to which he/she might have taken transfer admission ( ii ) and
thereafter obtain Post Graduate Diploma or Degree ( iii ) he/she shall if required by the
government serve the Government of Gujarat/ Rural Service or any District Panchayat
or any local authority as directed by the state Government for a minimum period of one
year on such remuneration as may be prescribed thereof ( iv ) he/she shall furnish the
government a personal security bond in the described form in the sum of Rs.
30,00,000/- ( Rupees Thirty Lakhs only ) executed by the student shall execute the bond
along with two sureties who have been certified as solvent by the competent authorities
in the said rules.

NOW THE CONDITIONS OF THE ABOVE WRITTEN BOND ARE THAT.

(i) The student shall diligently pursue and complete the Post Graduate Diploma
or Degree course at the said college in the state of Gujarat and strictly comply
with the rules of the said college. The student shall have to attend the college
 regularly and shall complete the coursepassing the prescribed university
examination.

(ii) After passing the said examination, the student shall within a period of 30
days, inform to the Commissioner of Health, Medical Services, Medical
Education and Research(hereinafter referred to as COH) to offer himself for
the Government/Rural Services and if the student is called upon by the
Government or COH, the student shall serve the Government / District
Panchayat I Local Authority for one year in such grade and remuneration as
may be prescribed by Government.

(iii) During the period of rural services, the student shallbe required to serve
under the provision of the bond, discharge the duties faithfully assigned to
him/her and observe the rules for the time being in force regulating the
conduct. The student cannot remain absent without prior permission of
competent authority.

IT IS HEREBY AGREED AS FOLLOWS:-

(a) In the event of the student committing a breach of any of the above terms and
conditions, the total sum of Rs. 30,00,000/- ( Rupees Thirty Lakhs only ) shall become
payable forthwith by the student's guardian and either of the sureties jointly and
severally and the Government may, without prejudice to any other rights and remedies
of the Government recover the same from the student and / or either of the sureties
jointly and severally at the discretion of the Government as arrears of land revenue and
can attach the land or property of the above.

(b) If the student before or after entering Government service, becomes ineligible for
appointment or continuation in Government service by his own misbehavior,
indiscipline or irregularity, he I she shall render himself/herself liable to pay to
Government in addition to the said bond amount penalty for breach of agreement as
may be decided by the concerned Government officer and such amount will be
recovered from the student I Guardian /either of sureties as the absolute discretion of
the Government.

(c) It shall not be necessary for the Government to inform any of the students before
suing the guardian or either of the sureties for recovering the amount due hereunder.

(d) The liability of the sureties hereunder or either of them shall not be discharged by
any reason . .
(e) Where the student is desirous of undergoing further studies and if he/ she secures
admission to course of further study in the same year, the bond of the student shall be
extended for the duration of the study and student shall be subject to the condition that
specific "No Objection Certificate", for pursuing the further studies is produced from the
Dean of the said college. Provided, however that if the stude".lt fails or neglects to pass
the course of further study examination within five years or abandons the further
studies prior thereto for any reason whatsoever, the conditions of the undertaking shall
be applicable to said student immediately. The Dean of the institute of such post
graduate student will inform Additional Director Medical Education about all such
candidates on 1st Jan and 30th June of each academic year.

IN WITNESS WHERE OF THE ABOVE NAMED.

Name of the student and Address Signature

Sureties
1. Name and Address Signature

2. Name and Address Signature

Witness
1. Name and Address Signature

2. Name and Address Signature

NOTARY
(Note :- Only attested Xerox copy of Aadhaar Card & Electricity Bill in the name of
Sureties & Witness should be attached with Bond Affidavit)
,.

Note:The duly executed Bond and Solvency Certificate are to be submitted at the time of
joining the Government Medical College to the Dean of respective college to which the
candidate has been admitted in the academic year 20 - 20 as per Government of Gujarat,
Health and Family Welfare Department, Resolution NO.MCG/1019/1643/J, dated ...... .......................... ..

BOND FOR STUDENTS PROVISIONALLY ADMITIED TO THE POST GRADUATE

DIPLOMA OR DEGREE COURSE

KNOW ALLMEN BY THESE PRESENT THAT WE _ _ _ _ _ _ _ _ _ _ _ _ (name of

student) son/daughter of Shri _ _ _ _ _ _ __ (hereinafter called 11The student" ) and 11 father or
natural guardian of the student", which expression shall unless excluded by or repugnant to the context
include his or her heirs administrators and assigns and _ _ _ _ _ _ _ _ _ _ _ __ son or
daughter or wife of Shri _ _ _ _ _ __ _
11
(Here in after called theSurety") which expression shall unless excluded by or repugnant to the context
include his/her heirs, administrators and assigns bind ourselves jointly and severally to pay to the
11
Governor of Gujarat (hereinafter called the Government") on demand and without demur a sum of Rs.
11
10,00,000/-(Rupees Ten Lakhs only) or if payment is to be made in a country other than that of India"
the equivalent of the said sum in the currency of that country converted at the official rate of exchange
between that country and India.

Dated this _ _ _ _ _ __ dayof _ _ _ _ _ _ _ _ _~ Twothousand _ __ _ _

WHEREAS, the Government has decided to prescribe a condition for admission to Government
Medical College for the Post Graduate Diploma or Degree course {hereinafter referred to 11 Said course")
that every student so admitted shall complete the said course from that college or from any other
Government Medical College in the state and that on such completion he or she shall if so required by
the Government serve in any of the rural areas of the state for a minimum period of 1 Year in the state
on such remuneration as my be prescribed other of and shall furnish a suitable bond for the due
performance of the said conditions .

AND WHEREAS, the student who had applied for admission for the said course in _ _ _ __
Medical College (hereinafter referred to as 11the said college.)NOW the condition of above written
obligation is that if the student shall:

{1) Fail to complete the Post Graduate Diploma or Degree course as here in above provided that
candidate shall pay to the Government on demand the amount of penalty of Bond as prescribed here
under.

{2) Diligently prosecute and comp lete the said course at the said college or any other Government
Medical College in the state and pass the prescribed university examination for the said course and
Within a period of 30 {Thirty) days from the date of passing final examination give to the Government by
REGISTRED POST NOTICE in writing provided however that if the student is desirous of continuing
further studies it shall be open to the Government in its absolute discretion to refuse such permission or
to grant it subject to condition that the student shall within one month from the completion of further
studies, give a like notice to the Government.

(3) When called upon by the Government shall at any time within a period of six months from the
receipt of the notice from the student as aforesaid join the State Service and serve in any of the rural
areas of the state for minimum period of one year in the state at such remuneration as may be
prescribed thereof and in the event of the student not being so called upon by the Government to join
the state services and serve them for the aggregate period of one year in any of the Rural Areas of the
state and during the period which the student is required to serve under provisions of this bond
faithfully discharge the duties assigned to him/her by the Government or his/her other superiors with
utmost diligence and efficiency and shall observe the rules for time being in force regulating the conduct
of persons so serving.
Then the above written bond shall become void otherwise the said shall remain in full force and
virtue.
And in the event of student committing a breach of any the above terms and conditions the
whole amount of Rs.40,00,000/- (Rupees Forty Lakhs only) (i.e. Solvency Certificate or Bank Guarantee
of Rs. 10.00 Lakhs and Undertaking of Rs. 30.00 Lakhs) as per Government of Gujarat, Health and
Family Welfare Department, ResolutionNO.MCG/1019/1643/J,dated ............................. or such lesser
sum as the Government may in its absolute discretions decide shall become payable jointly, or severally
by the student or the father/natural guardian of the student and the above surety
_ _ _ _ _ _ _ _ _ _ _ _ (full name of the surety) forthwith and the
Government may without prejudice any other right and remedies of the Government recover the same
from the student or the father or natural guardian of the student and the above surety.

(Full name of the surety)

And upon making of such payment the above written obligation shall be void and of no effect otherwise
it shall be and remain in full force and virtue;

Provided always and it is hereby agreed and declared that the decision of the Government at
whether the said student has or has not performed and observed any of the obligations. and conditions
herein before recited and the amount of the compensation payable in this behalf shall be final and
binding on the parties hereto.

Provided further that the liability of the surety here under shall not be impaired or discharged
by reasons of timebeing granted or any forbearance, act of omission of the Government (With or
without knowledge or consent of surety) in respect of or in relation of several obligations and
conditions to be performed or discharged by the student provided that the Government may without
prejudice to any other rights or remedies of the Government recovery such amount due here under
from student or from the father or natural guardian of the student or from surety as an arrears of land
revenue and provided further that this bond shall in all respect be governed by the laws of India.
 I witness whereof the said student or father or natural guardian of the student in case he is a
minor and the said surety have put their respective hands day and the year herein above written

Signed and delivered by the within

Named student or father or natural (Signature of student or father or natural Guardian of Student)
Guardian of the student

in presence of-

1. Signature:

Full Name:

2. Signature :

Full Name:

Signed and delivered by the within

(Signature with full address of surety.)
Name surety in presence

1. Signature:

Full Name:

2. Signature:

Full Name:

Accepted by _ _ _ _ _ _ _ _ _ _ _ _ _ _ granted on behalf of Gujarat.

 CERTIFICATE OF SOLVENCY

This is to certify_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

(Full name with address of surety)

(Contact no, E-mail -id and UIDAI No. are mandatory)

Who has stood as surety t o - - - - - - - - - - - - - - - - - - - - -

(Full name with address of student)

(Contact no, E-mail -id and UIDAI No. are mandatory)

A candidate seeking admission to the Post Graduate Diploma or Degree Course is solvent to the
extent of the amount stipulated in Bond by the student or father or natural guardian of the
student in respect of above mentioned admission.

This certificate is issued on the strength of the attached solvency certified Dated
_ _ _ _ _ _ _ _ _ (in the form No.R.S.B 2g produced by the said surety.)

Passport size Place: Signature of the Collector

Photograph of
The Candidate

Date: Dy. Collector/Mamlatdar

Seal Designation:
 FORM NO.R.S.B 2g

FORM OF SOLVENCY CERTIFICATE

(No solvency certificate more than a month old will be accepted)

As per Government of Gujarat Heath and Family Welfare Department Gandhinagar

Resolution NO.MCG/1019/1643/J, dated ..............................

Property's Market Value should be more than Rs.10,00,000/-(Rupees Ten Lakhs only)

1. Name
2.Father's Name
3. Residence
4.Age
5. Occupation
6. Purpose for which required
7. Whether the person certified possesses movable or immovable property or both:
8. If movable estimated value and grounds for belief:

9. If immovable

A. If in lands

a. Areas and where situated

b. Assessment
c. Market Value
d. Whether it is in the sole ownership of the certified and whether they have any objections to
urge.
e. Whether it is a join Hindu Family property and if so the extent of his share, the names of
other coparceners and whether they have objection to urge.

B. If in house:

a. Where situated
b. Market Value
c. Whether it is in the sole ownership of the person certified and whether they have any
objections to urge.
d. Whether it is a join Hindu Family and if so the extent of his share, the names of other
coparceners and whether they have objection to urge.

Declaration by the person being certified on solemn affirmation

 I have solemnly declare that the property described and immovable property mentioned
above is unencumbered.

Date: Signature

Signature in the presence of:

10. Report of the village officers of the place where the property is situated.
11. Opinion of the certifying officer.

Camp: Signature

Date:

N.B:- Asregard Nos. 8, 9 and 10, if the particulars required cannot be conveniently entered
against them they should be appended on separate sheets and the signature of the certifying
office and note to that effect against the number of item concerned.

Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _~
Father's Name
-------------------------
Res icid enc e
~--------------------------
Age. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Occupation _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Certifying Officer.