1

FORM 1
FORMATE FOR PARTICULARS OF THE COLLEGE/INSTITUTE FOR THE EXISTING
MEDICAL COLLEGE/PROPOSED TO ESTABLISH NEW MEDICAL COLLEGE/PROPOSED
TO INCREASE THE SEATS

1 NAME OF THE APPLICANT
(STATE GOVERNMENT./UNION
TERRITORY/UNIVERSITY/ SOCIETY
/TRUST)
Surat Municipal Corporation
Name of the college:
Surat Municipal Institute of Medical
Education & Research (SMIMER-)
2 ADDRESS NO., STREET, CITY, PIN CODE,



TELEPHONE NOS.
FAX NO.
Surat Municipal Institute of Medical
Education & Research (SMIMER)
Opp. Bombay Market, Umarwada,
Surat-395 010. Gujarat (India)
Phone No: 091-261- 2368040 to 43;
FAX No: 091-261- 2343241
3 ADDRESS OF REGISTERED OFFICE
NO., STREET, CITY, PIN CODE,


TELEPHONE NOS.
FAX NO.
Surat Municipal Corporation
Muglisara Daria Mahal,
Surat 395003
0261-2423751 to 56 & 2422285 to 87
0261- 2451935 &2422110
4 CONSTITUTION
(STATE GOVERNMENT/UNION
TERRITORY / UNIVERSITY
AUTONOMOUS BODY, SOCIETY, TRUST)
Surat Municipal Corporation
(Local self government-Autonomous Body)
5 REGISTRATION/INCORPORATION
(NUMBER AND DATE)
Not Applicable To Surat Municipal
Corporation
6 NAME OF AFFILIATING UNIVERSITY: Veer Narmad South Gujarat University,
(VNSGU), Surat

2

7 CATEGORY OF APPLICANT
(STATE GOVERNMENT/UNION TERRITORY/
UNIVERSITY /SOCIETY /TRUST)
Surat Municipal Corporation
(Local self government autonomous body)
8 BASIC INFRASTRUCTURAL FACILITIES
AVAILABLE FOR MEDICAL COLLEGE AND
ATTACHED HOSPITAL (PLEASE ADD A SEPARATE
SHEET IF NECESSARY)
Annexure-I
9 MANAGERIAL CAPABILITY:- Composition of the Society /Trust Particulars of Members of the
Society/Trust, Head or Project Director of the Proposed Medical College, Head of the Existing Hospital
Their Qualification and Experience in the Field of Medical Education.

Item

College Dean Medical
Superintendent
Name

Surat Municipal Institute of
Medical Education &
Research
Dr. Kalpana
A Desai
MD (Anesthesia)
Dr. Vandana Desai
MD (Paediatrics)
Address


Umarwada,
Near Bombay Market, Surat
SMIMER,
Umarwada, Near
Bombay Market, Surat
SMIMER,
Umarwada, Near
Bombay Market, Surat
State Gujarat Gujarat Gujarat
Pin Code 395010 395010 395010
Phone
Office 0261-2368040-42
(EPBX)
0261-2366367 (Direct) 0261-2368040-43
Ext 1600
Res -- 0261-2252858 0261-2236849
Fax 0261-2343241 0261-2343241 0261-2360306
Mobile 09724345012 09724345013
E-mail deansmimer@ gmail.com deansmimer@
gmail.com
vmdesai@
rediffmail.com

10 FINANCIAL CAPABILITY
Balance sheet for the last 3 years to be provided if the
applicant is a society / trust.
Owned and completely Financed by Surat
Municipal Corporation
Please refer Annexure- VI
3

PART II

11 NAME AND ADDRESS OF THE EXISTING
MEDICAL COLLEGE
Surat Municipal Institute of Medical
Education and Research (SMIMER)
Opp. Bombay Market, Umarwada,
Surat - 395 010 (Guj)-India.
12 MARKET SURVEY AND ENVIRONMENTAL
ANALYSIS

a) Give the main features of the state medical
education policy.
b) Availability of trained medical manpower in the
state and need for increase in the provision of
medical manpower
c) Gap analysis and how the gap will be reduced.
d) Catchment area in terms of patients for the
proposed medical College / hospital.
e) No. of hospitals/primary health centres/private
clinics available in the Catchment area.




SMIMER medical college is in existence
since 2000-2001

f) State how will the existing medical facilities get
augmented by the establishment of proposed
medical college.
Merging of new areas & surrounding villages
into the Municipal Corporation
13 SITE CHARACTERISTICS AND AVAILABILITY OF EXTERNAL LINKAGES.
a) Topography Please refer Annexure- III
(Master plan of the Medical College
Complex)
b) Plot size


T.P.S. NO. / F.P. NO. Area in Sq. mtrs.

T.P.S NO. 8/ F.P. NO. 64 108472.00

T.P.S NO. 8/ F.P. NO. 64 30728.00

R.S. NO. / F.P. NO.


R.S. NO. 125 Paikee + 127/F.P.
No. 30/A & 30/B, etc
92719.00
c) Permissible floor space index
As per GDCR norms of State Govt.
d) Ground coverage
As per GDCR norms of State Govt.
e) Building height College: A, B, C blocks (Academic blocks
with 3 floors each)
Administrative block with two floors
Hospital: G+6 floors
f) Road access Medical College is in the center of the city
and easily approachable to general public
with well road connectivity.
g) Availability of public transport Approachable with all modes of
transportation
h) Electric supply Round the clock facilities are available.

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i) Water supply
Continuous round the clock water supply is
ensured.
j) Sewage connection
Yes
k) Communication facilities
Yes
14 EDUCATIONAL PROGRAMME
a) Proposed annual intake of students Recognized Seats 100
Permitted for additional seats 50
Please see the Annexure XIII
b) Admission criteria
Combined Std. 12 and GUJCET marks as per
MCI norms
In case of NRI seats as per MCI norms
Please see the Annexure XIV
c) Method of admission Centralized admission criteria as laid down by
Govt. of Gujarat & MCI.
d) Reservation/preferential allocation of seats: As per Govt. norms: Local quota: 70, All
Gujarat quota: 57 seats it includes reservation
for 15 % ST, 7 % SC, 27% OBCs)
( NRI: 15 % (23 seats)
Department wise and year wise curriculum of studies. - South Gujarat University, Surat has
adopted revised regulations of undergraduate medical education as prescribed by Medical
council of India.
Names of Subjects Duration of study
First M.B.B.S. Anatomy,
Physiology,
Biochemistry
One year
(1
st
& 2
nd
semesters)
Second M.B.B.S. Pathology
Pharmacology
Forensic Medicine
Microbiology
One and half year
(3
rd
, 4
th
& 5
th
semesters)
Final M.B.B.S.
Part-I ENT
Ophthalmology,
Community Medicine
(6
th
& 7
th
semesters)

Part-II Medicine (Including
Paediatrics)
Surgery (Including
Orthopedics)
Obstetrics & Gynecology
(8
th
& 9
th
Semesters)


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15 FUNCTIONAL PROGRAMME
Department wise & service wise functional
requirements

As per MCI recommendations
Area distribution and room wise sitting capacity
16
EQUIPMENT PROGRAMME:
Room wise list of Equipments complete with year
wise schedule of quantities and specifications
(a) Medical (b) Scientific (c) Allied Equipments
As per MCI recommendations
Please see Annexure I C
17
MAN POWER PROGRAMME

Department wise and year wise requirements of
(a) Teaching staff (full time)
As per MCI recommendations
Please see Annexure I D

(b) Technical staff
(c) Administrative staff
(d) Ancillary staff
(e) Salary structure As per SMC resolutions (Annexure- XV)
(f) Recruitment procedure By publishing the advertisement.
Selection through recruitment committee and
through DPC constituted by University as per
MCI norms / SMC rules & regulations.
(g) Recruitment calendar As and when required.
18
BUILDING PROGRAMME
Building wise built up area of

(a) Medical college (departments, lecture theatre,
museum etc.)
Medical college: 19179.67 Sq.mts
(Kindly refer Annexure 1A)
(b) Examination hall
398.40 Sq.mts
(c) Faculty and staff housing
Teaching staff 5840.72 Sq.mts
Nursing & Paramedical staff 7037.66 Sq.mts
(d) Staff and students hostels
14396.42 Sq.mts
(e) Administrative office
College : 1348.45 Sq.mts
Hospital : 632.48 Sq.mts
(f) Library
2347 sq.mts
(g) Auditorium
Surat Municipal Corporation Auditorium is of
1200 capacity, available for use for SMIMER.
(h) Animal house
142 Sq.mt
(i) Mortuary
402.53 Sq.mts
(j) Cultural and recreational centre
Available in the campus
(k) Sport complex
10067.21 Sq.mts
(l) Others (state name of the facility)
--
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PLANNING AND LAYOUT
(a) Master plan of the medical college complex
For copy of master layout plan
Kindly refer Annexure III
(b) Layout plans, sections
(c) Elevations and floor wise area calculations of the
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medical colleges and ancillary buildings.


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PHASING AND SCHEDULING
Month wise schedule of activities indicating


COMPLETED
(a) Commencement & completion of building design
(b) Local body approvals
(c) Civil construction
(d) Provision of engineering services and equipment
(e) Requirement of staff
(f) Phasing of commissioning

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PROJECT COST
100% funded by the Surat Municipal Corporation

a) Capital cost of land
b) Buildings
c) Plant and machinery
d) Medical, scientific and allied equipment
e) Furniture and fixtures
f) Preliminary and preoperative expenses

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MEANS OF FINANCING THE PROJECT The entire project cost is incurred by Surat
Municipal Corporation.
(a) Contribution of the applicant --
(b) Grants --
(c) Donations --
(d) Equity --
(e) Term loans --
(f) Other sources (if any) --
23
REVENUE ASSUMPTIONS
(a) Fee structure Please see Annexure - XVII
(b) Estimated annual revenue from various sources Please see Annexure - XVIII
24
EXPENDITURE ASSUMPTIONS
(a) Operating expenses
Rs. 6.31 cr.
(b) Depreciation
25
OPERATING RESULTS
(a) Income statement
Kindly refer Annexure - VI (b) Cash flow statement
(c) Projected balance sheets
NOTE - For Items 14 to 18 a comparative statement showing the relevant Medical Council of India norms vis--
vis infrastructure/faculty available and/or proposed to be made available should be annexed.


7

PART III

26 NAME AND ADDRESS OF THE
EXISTING HOSPITAL
Surat Municipal Institute of Medical
Education and Research (SMIMER)
Opp. Bombay Market, Umarwada,
Surat - 395 010 (Gujarat)-India.
27 DETAILS OF THE EXISTING HOSPITAL INCLUDING
a) Bed strength ( Total teaching beds) 686
b) Bed distribution, bed occupancy and
whether a norm of 5 in patients per student
would be fulfilled.

Yes

a) Medicine & Allied Specialties Number of
Teaching
Beds
Number
of Units
Average bed
occupancy/ day
(% of Teaching beds)
(Apr 09-
Mar 10)
(Apr 10-
Oct10)
1) General Medicine 150 05 85.60 % 103.43%
2) Pediatrics 90 03 126.01% 105.05%
3) Tuberculosis & Respiratory Disease 30 01 45.60 % 68.85%
4) Dermatology, Venerology & Leprosy 13 01 45.11 % 64.68%
5) Psychiatry 13 01 23.86 % 30.87%
Total 296 11 65.24 %
b) Surgery & Allied Specialties Number of
Teaching
Beds
Number
of Units
Average bed
occupancy/ day
(% of Teaching beds)
(Apr 09-
Mar 10)
(Apr 10-
Oct10)
1) Gen. Surgery including Paediatrics
Surgery
150 05 84.74 % 77.62%
2) Orthopaedics 90 03 86.14 % 68.79%
3) Ophthalmology 30 01 39.07 % 37.38%
4) Oto-rhino-laryngology 30 01 56.90 % 90.32%
Total 300 10 66.71 %
c) Obstetrics & ANC Gynecology Number of
Teaching
Beds
Number
of Units
Average bed
occupancy/ day
(% of Teaching beds)
(Apr 09-
Mar 10)
(Apr 10-
Oct 10)
1) Obstetrics & Gynecology 90 03 86.95 % 79.08%
Grand Total 686 24 72.97 %

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c) Built up area 44115 sq.mt (Annexure I B)
d) Clinical and Para-clinical disciplines (Annexure I A)
e) OPDs and IPD attendance department wise Annexure II
f) Architectural and layout plans Annexure III
g) List of medical/allied equipments Annexure - IC
h) Capacity and configuration of engineering
services
Available
i) Hospital services, administrative services,
other ancillary and support services
(category wise staff strength)
Annexure - IB


Up-gradation And Expansion Programme:
Structural and function capacity of Surat Municipal Institute of Medical Education & Research, is for 150
undergraduate seats and hospital capacity is 750 beds so there is no need to upgrade or expansion of
college or hospital building in short coming days.

9

28 DETAILS ABOUT THE ADDITIONAL LAND FOR EXPANSION OF THE EXISTING
HOSPITAL
a) Land particulars
b) Distance from the proposed medical
college

c) Plot size
d) Authorized land usage
e) Geography
f) Soil condition
g) Road access
h) Availability of public transport
i) Electric supply
j) Water supply
k) Sewage connection
l) Communication facilities
29 UPGRADED MEDICAL PROGRAMME :- Year wise details of the additional clinical &
Para clinical disciplines envisaged under the expansion programme
30 UPGRADED FUNCTIONAL
PROGRAMME

a) Specialty wise and service wise
functional requirements

b) Area distribution
c) Specialty wise bed distribution

10

31 BUILDING EXPANSION PROGRAMME: Year wise additional built-up area to be provided
for
a) Hospital
b) Staff housing
c) Staff and students hostels
d) Other ancillary buildings
32 PLANNING AND LAYOUT: Upgraded master plan of the hospital complex along with
a) Layout plans
b) Sections
c) Elevations
d) Floor wise area calculation of the
hospital

e) Floor wise area calculation of
ancillary buildings

33 DETAILS ABOUT UPGRADATION OR ADDITION IN THE CAPACITY AND
CONFIGURATION OF ENGINEERING SERVICES AND HOSPITAL SERVICES
34 EQUIPMENT PROGRAMME Upgraded room wise list of
a) Medical and allied equipments
b) Schedule of quantities
c) Specifications
35 UPGRADED MANPOWER PROGRAMME Category wise distribution of
a) Medical staff
b) Para-medical staff
c) Other staff
36 PHASING AND SCHEDULING OF THE EXPANSION OF SCHEME Month wise schedule of
activities indicating
a) Commencement and completion of
building design

b) Local body approvals

c) Civil construction

d) Provision of engineering & hosp. services
e) Provision of medical & allied equipment

f) Recruitment of staff


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37
PROJECT COST OF THE EXPANSION SCHEME- Cost of additional
a) Land
b) Buildings

c) Engineering services

d) Hospital services
e) Medical and allied equipments

f) Furniture and fixtures

g) Preliminary and pre-operative expenses
38 MEANS OF FINANCING THE PROJECT
a) Contribution of the applicant
b) Grants
c) Donations

d) Equity

e) Term loans
f) Other sources, if any

39 REVENUE ASSUMPTIONS: Income from
a) Various procedures and services

b) Upgraded service loads

c) Other sources
40 EXPENDITURE ASSUMPTIONS
a) Operating expenses
b) Financial expenses

c) Depreciation

41 OPERATING RESULTS
a) Income statements

b) Cash flow statements
c) Balance sheet








(Signature of Applicant)
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SURAT MUNICIPAL INSTITUTE OF MEDICAL EDUCATION &
RESEARCH (SMIMER), SURAT

LIST OF ANNEXURES ATTACHED

ANNEXURE- I BASIC INFRASTRUCTURAL FACILITIES AVAILABLE FOR MEDICAL COLLEGE AND
ATTACHED HOSPITAL
ANNEXURE- I A EXISTING INFRASTRUCTURE AT MEDICAL COLLEGE SMIMER, SURAT
ANNEXURE- I B EXISTING INFRASTRUCTURE AT SMIMER HOSPITAL, SURAT
ANNEXURE- I C LIST OF INSTRUMENT / EQUIPMENTS
ANNEXURE- I D DEPARTMENT WISE AND YEAR WISE REQUIREMENTS OF TEACHING STAFF ,
TECHNICAL STAFF, ADMINISTRATIVE STAFF & ANCILLARY STAFF
ANNEXURE- II OPDS AND OPD ATTENDANCE DEPARTMENT WISE
ANNEXURE- III MASTER PLAN OF THE MEDICAL COLLEGE COMPLEX
ANNEXURE- IV
(ENCLOSURE-1)
COPY OF BYE LAWS / MEMORANDUM AND ARTICLES OF ASSOCIATION / TRUST
DEED
ANNEXURE- V
(ENCLOSURE-II)
COPY OF CERTIFICATE OF REGISTRATION/INCORPORATION.
ANNEXURE- VI
(ENCLOSURE-III)
ANNUAL REPORTS AND AUDITED BALANCE SHEETS FOR THE LAST THREE YEARS
ANNEXURE- VII
(ENCLOSURE-IV)
COPY OF THE TITLE DEEDS OF THE TOTAL AVAILABLE LAND AS PROOF OF
OWNERSHIP.
ANNEXURE- VIII
(ENCLOSURE-V)
COPY OF ZONING PLANS OF THE AVAILABLE SITES INDICATING THEIR LAND USE
ANNEXURE- IX
(ENCLOSURE-VI)
PROOF OF OWNERSHIP OF EXISTING HOSPITAL
ANNEXURE- X
(ENCLOSURE-VII)
CERTIFIED COPY OF THE ESSENTIALITY CERTIFICATE ISSUED BY THE
RESPECTIVE STATE GOVERNMENT/UNION TERRITORY ADMINISTRATION.
ANNEXURE- XI
(ENCLOSURE-VIII)
CERTIFIED COPY OF THE CONSENT OF AFFILIATION ISSUED BY A RECOGNISED
UNIVERSITY.
ANNEXURE- XII
(ENCLOSURE-IX)
AUTHORIZATION LETTER ADDRESSED TO THE BANKERS OF THE APPLICANT
AUTHORIZING THE CENTRAL GOVERNMENT./MEDICAL COUNCIL OF INDIA TO
MAKE INDEPENDENT ENQUIRIES REGARDING THE FINANCIAL TRACK RECORD OF
THE APPLICANT.
ANNEXURE-XIII PROPOSED ANNUAL INTAKE OF STUDENTS
ANNEXURE- XIV ADMISSION CRITERIA , METHOD OF ADMISSION & RESERVATION/PREFERENTIAL
ALLOCATION OF SEATS
ANNEXURE- XV SALARY STRUCTURE
ANNEXURE- XVI PROJECT COST
ANNEXURE- XVII FEE STRUCTURE
ANNEXURE- XVIII ESTIMATED ANNUAL REVENUE FROM VARIOUS SOURCES




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Form II
Essentiality Certificate; Permanent Affiliation by Government of Gujarat


14

Essentiality Certificate; Permanent Affiliation by Government of Gujarat


15

Essentiality Certificate; Permanent Affiliation by Government of Gujarat




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FORM III
Essentiality Certificate; Permanent Affiliation by VNSG University, Surat










17

Essentiality Certificate; Permanent Affiliation by VNSG University, Surat



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FORM IV
Undergraduate Degrees Recognition for 100 seats by Govt. of India
Letter No.U.12012/ 34/99-ME (P-II) Dated 1st July 2005



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