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This document is a verification form for admission to MBBS/BDS programs in medical/dental colleges in West Bengal for a given year. It collects information such as the applicant's name, address, date of birth, caste/tribe if applicable, preference for selection criteria, and higher secondary examination details. The applicant and father/guardian must declare that the information provided is true and agree to the terms of admission outlined in the advertisement. They acknowledge the original documents required at counseling and that original certificates will be deposited until course completion, with penalties for discontinuing the program.
This document is a verification form for admission to MBBS/BDS programs in medical/dental colleges in West Bengal for a given year. It collects information such as the applicant's name, address, date of birth, caste/tribe if applicable, preference for selection criteria, and higher secondary examination details. The applicant and father/guardian must declare that the information provided is true and agree to the terms of admission outlined in the advertisement. They acknowledge the original documents required at counseling and that original certificates will be deposited until course completion, with penalties for discontinuing the program.
This document is a verification form for admission to MBBS/BDS programs in medical/dental colleges in West Bengal for a given year. It collects information such as the applicant's name, address, date of birth, caste/tribe if applicable, preference for selection criteria, and higher secondary examination details. The applicant and father/guardian must declare that the information provided is true and agree to the terms of admission outlined in the advertisement. They acknowledge the original documents required at counseling and that original certificates will be deposited until course completion, with penalties for discontinuing the program.
SWASTHYA BHAWAN, BLOCK-GN, SECTOR-V, KOLKATA-700091. Verification Formfor Admission to the 1 st Year MBBS / BDS Course in the medical / Dental Colleges in West Bengal for the year to All columns should be filled in. None should be left blank. ROLL NO: APPLICATION NO:.. OVERALL STATE RANK: (As mentioned in the WBJEEM Overall Rank 2014) Admitted in (For Official Use)
1. Name of the Applicant :
(In BLOCK LETTERS) 2. (a) Name of the Father .. (b) Name of the Mother . (c) Name of Guardian :(If not Father, then the reason thereof) 3. Address of the Applicant : (a) Present Address : . (Where communication is to be made) (b) Phone No. Email.. Permanent Address :. (b) Phone No. Email.. 4. If belongs to Scheduled Castes / Scheduled Tribes/Other Backward Classes (A / B) 5. Write (YES /NO) N.B. If Yes , an attested copy of SC/ST/OBC A/OBC B certificate from the appropriate authority mentioning the Sub-Caste/ tribe must be enclosed. Otherwise the application will not be considered. (Attach attested copy of appropriate documents) 6. If belongs to Physically Handicapped. Write (YES /NO):. N.B. If Yes, an attested copy of PH certificate from the appropriate authority must be enclosed. Otherwise the application will not be considered. (Attach attested copy of appropriate documents) 7. (a) Date and Year of Birth
(b) Age as on 31 st December of the Year of Admission (2014)
According to English Calendar as per Madhyamik/ Equivalent Examination Certificate/ documents like Admit Card etc. (Attach attested copy of appropriate document). 8. Whether he /she likes to be considered against 8(a) or 8(b)-Mention either a or b (a) Candidates residing uninterruptedly in the State of West Bengal for a minimum period of ten years prior to the date of making application for admission to MBBS/ BDS Course . OR (b) Candidates who or whose parents are permanent / resident of West Bengal having their permanent Address in the State of West Bengal. 9. Higher Secondary (10+2) or Equivalent Examination as per advertisement
(Attach attested copy of appropriate document). 10. Declaration by the Applicant and Father / Guardian : We jointly declare that all foregoing statements are true to the best of our belief and knowledge. Any Statement, made in the Application, if found incorrect or incomplete, on Scrutiny, will render the Application liable to rejection and admission if granted on the basis of such incorrect statement may be cancelled without any intimation to any of us. We further declare that we have gone through the terms and conditions of Advertisement and Instructions and agree to abide by the conditions laid down therein. We also agree that the decision of the Central Selection Committee (Medical) with regard to Selection, Allotment and Admission to any of the colleges will be acceptable to and binding on us. We are aware that the following Original Documents are to be produced during Counselling (If any name is in the Merit List):- 1. Class X Admit Card / Mark Sheet (Documenting the Date of birth). 2. Class ( 10+2) Mark Sheet & Certificate. 3. Examination Results WBJEEM 2014(rank card). 4. Allotment letter obtained from www.wbmcc.nic.in 5. SC/ ST/ OBC A/OBC B/ PH Category Certificate (Wherever Applicable). 6. Domicile Certificate- Candidates copy in the prescribed Application Form available in information brochure of WBJEEM 2014 must be produced. 7. Medical Certificate. 8. Voter ID card of any of the parents or candidate (as applicable) We are also aware that Original 10+2 Examination Certificate and Original Mark sheet are to be deposited at the time of Admission without fail till the completion of the Course. In case of any Discontinuation from the Course offered or Resignation from the Course after Reconciling of this State, all Original Documents shall be returned only on payment of a penalty charge of Rs. 1,00,000/- (Rupees One Lakh) only asper G.O. No. HF/O/MERT/1542/Admin/ME/STM-28-10/2(10) dt 25/10/10. All Originals will be Verified at the time of Counselling ... (Signature of Father/ Guardian) (Signature of Applicant) Place. Place. Date.. Date..