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TERNA PUBLIC CHARITABLE TRUSTS

TERNA MEDICAL COLLEGE & HOSPITAL


Sector 12, Phase II, Nerul (W), Navi Mumbai 400 706,Maharashtra ,India
Ph.+ 022-27720563/ 27723664 / 27721442 Fax + 022- 27716314
E-mail :-terna_medical@yahoo.co.in website:-ternamedical.org

List of the Documents to be submitted


At the Time of Admission for the Academic Year
2016-17
Please submit 1 Original Set + 3 Sets of Attested Xerox Copies of each
Document in the following sequence:-
1. Indian Nationality Certificate
2. Domicile Certificate
3. SSC Mark Sheet & Passing Certificate
4. HSC Mark Sheet & Passing Certificate
5. Neet CET 2016 Mark-sheet & NEET selection Letter
6. Medical Fitness Certificate ( as per NEET-UG-2016 Preference Book )

7. Gap Certificate
8. Caste Certificate, Caste Validity Certificate, Non-Creamy Layer (Applicable for
reserved category students)
9. Migration Certificate
10. Transfer certificate/ Leaving certificate
11. Birth Certificate
12. Undertaking on Rs. 100/- stamp paper duly signed before the Notary for
yearly payment of fees on due date
13. Undertaking for Anti ragging activity on Rs.100 stamp paper duly signed
before the Notary .
14. Character Certificate issued by the Principal of last school / junior College
attended mentioning the status of his/her behavioural pattern specially in
terms as to whether he /she has displayed persistent violent or aggressive
behaviour or any desire to harm others. (As per provision made in clause 4
of Anti Ragging Rules /Act.)
14. 4 Passport size Photographs.
Note :- 1. No admission will be done in absence of any applicable required
certificate .
TERNA PUBLIC CHARITABLE TRUSTS

TERNA MEDICAL COLLEGE & HOSPITAL


Sector 12, Phase II, Nerul (W), Navi Mumbai 400 706,Maharashtra ,India
Ph.+ 022-27720563/ 27723664 / 27721442 Fax + 022- 27716314
E-mail :-terna_medical@yahoo.co.in website:-ternamedical.org

Fees Details
Ist year MBBS Admission-2016-17

1. Ist Year MBBS fees - Rs. 4,62,000/- OPEN


- Rs.2,48,111 /- OBC
- Rs. 34,222/- SC,ST,VJ,NT

*The fee prescribed above is subject to change by Shikshan Shulk Samiti. Therefore the
students will have to pay the difference of fees fixed by Shikshan Shulk Samiti.
(To be paid by D.D.in favour of Dean, Terna Medical College, Nerul , Navi Mumbai)
------------------------------------------------------------------------------------------------------------
2. Caution Money Deposit - Rs. 10,000/-
(To be paid by D.D.in favour of Dean, Terna Medical College, Nerul , Navi Mumbai)
----------------------------------------------------------------------------------------------------
3. MUHS University fees (Sport, Welfare fund & Development) - Rs.350/-
(To be paid in Cash)
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4 . Amartya Shiksha Yojana Insurance Scheme - Rs. 2020/-

(To be paid by D.D. in favour of National Insurance Co. Ltd.Payable at Kolhapur.)


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5. Hostel Fees (fees 50000 + Deposit 10000):- Rs. 60000/-

(To be paid by DD in favour of Terna Public Charitable Trust,Nerul,Navi Mumbai)


----- ---------------------------------------------------------------------------------------------------
6. Undertaking for fees on Rs.100 Stamp Paper duly signed before the Notary.
----------------------------------------------------------------------------------------------------------
7. Undertaking for Anti ragging activity on Rs.100 stamp paper duly signed before
the
Notary (As per clause No.4 of the Undertaking Character Certificate should be
submitted from previous college along with the Undertaking. )
----------------------------------------------------------------------------------------------------------
8.MUHS Eligibility Fee to be paid in cash

OPEN Candidate MUHS elgibility fee Rs.7150/- cash

OBC ,SC,VJ,ST,NT1,NT2,NT3 MUHS eligibility fee Rs. 2200/- cash


***************.

PROFORMA (Undertaking)

Undertaking by student

On stamp paper of Rs.100/-

UNDERTAKING

I,____________________________ S/o _______________________of


Mumbai, Indian Inhabitant, residing at __________________________do
solemnly affirm and state as under:

1. I say that I have appeared for the NEET 2016 examination to secure
admission in the academic year 2016-17 in Medical/Dental Colleges.

2. I say that solely on the basis of merit I have been admitted to the
Terna Medical College in 1st year MBBS Course for academic year
2016-17.

3 I say that at the time of obtaining my admission I have paid a sum


of Rs.462000/- as fees for 1st year MBBS Course.

4. I say that I am fully aware that the aforesaid fees paid by me are
interim fees and

are subject to revision at any time. In the event of the fees being
increased by the

Shikshan Shulka Samiti or Judicial Pronouncement, I hereby


undertake to pay the

amount of difference of the fees within a period of 7 days from


being notified.
Solemnly affirmed at Mumbai

This _____day of ____________2016 Before Me

[ Identified by me:__________________

NOTARY

ANNEXURE K

Proforma (Undertaking)

Undertaking by student seeking admission

(Rs.100 Stamp paper)

UNDERTAKING

Name of Student :

Roll No. :

Year of Study :

Hostel Room no. (if any)

I____________________________________S/O __________________________________ of Mumbai,


Indian inhabitant residing at (Permanent address)
____________________________________________________________________________________________
do solemnly affirm and state as under :

1. I have a local guardian Shri ________________residing at


___________________________________________ phone no.____________________, who can
be contacted if required.

2. I say that solely on the basis of merit I have been admitted to


the__________________________ college in Ist Year _____________ course in the year
________________________________________________.

3. I say that I have read the relevant instructions and guidelines / rules against ragging
and consequences of indulging in ragging as well as the punishments under the rules
of the ragging issued by the competent authorities from time to time.

4. I am submitting herewith a character certificate from my College (specify Name of


College last attended)____________________________________ mentioning the status of
my behavioural pattern specifically in terms as to whether I have displayed
persistant violent or aggressive behaviour or any desire to harm others.

5. I, the parent / guardian of the student, say that I have gone through the relevant
instructions/regulations against ragging as well as punishments and that if my ward
has been found guilty, he / she shall be proceeded against, shall be prosecuted.

6. I have taken / not taken the admission in the college hostel and I will be abide by
the rules and regulations of hostel and as well as anti ragging rules issued from time
to time by government, court and college authorities.

7. Some of the relevant Provisions of ragging and Punishment to be awarded are


furnished below :-
All students are informed that RAGGING in educational institution have been prohibited by
Maharashtra Government under the Maharashtra Prohibition of Ragging Act, of 1999. Any
student or group of students, doing any act which causes or is likely to cause physical or
psychological harm or raise apprehension or shame or embarrassment to a student in the
college, will be convicted. It includes teasing , abusing, threatening or playing practical
jokes or causing hurt to such student or group of student or (ii) asking a student to do any
act or perform something which such student will not in ordinary course willing to do.

Any student directly or indirectly commits / participates in, abets or propagates, ragging
within or outside the college premises shall, on conviction, BE PUNISHED WITH
IMPRISONMENT FOR A TERM EXTENDED TO TWO YEARS AND SHALL ALSO BE
LIABLE TO FINE WHICH MAY EXTEND TO Rs.10000/-.

ANY STUDENT CONVICTED OF AN OFFENCE UNDER SECTION 4 (RAGGING) BE


DISMISSED FROM THE COLLEGE AND SUCH STUDENT SHALL NOT BE ADMITTED IN
ANY OTHER INSTITUTION FOR A PERIOD OF 5 YEARS from the date of dismissal
order.

Name & Signature of Parent Signature of Candidate


1. Local Address
(In case of outside students staying

independently by hiring room/ private hostel, Dhramshala etc.)

TERNA PUBLIC CHARITABLE TRUSTS

TERNA MEDICAL COLLEGE & HOSPITAL


Sector 12, Phase II, Nerul (W), Navi Mumbai 400 706,Maharashtra ,India
Ph.+ 9122-27720563/ 27723664 / 27721442 Fax + 9122- 27716314
E-mail :-terna_medical@yahoo.co.in website:-ternamedical.org

Academic Year - 2016-17


Whichever is applicable) a) NEET Exam2016 Merit List

b) Vacancy Round

c) NRI / Against NRI

A PERSONAL INFORMATION OF CANDIDATE


1. Name of the Applicant (in block letters)

as given in the qualifying examination

certificate. Surname should be underlined

2. Permanent Home Address (Native place)

Tel. No. With STD CODE Email ID

3 Present address for Correspondence

Telephone No. (Inform the Principal


immediately of

Any change in the Address & Telephone No.)

4. Date of Birth

5. Nationality of the Candidate

6. Sex Male/Female
7. Religion

8. Caste

9. Do you belong to

SC/ST/VJ/ NT1/N2/N3/OBC /OPEN

(A certificate as a proof is essential)

10. Aadhar Card No.

11. Marital Status Married/Unmarried

B PERSONAL

INFORMATION OF PARENT/GUARDIAN

1. Father's Name

2. Mother's Name

3. Guardian (if parents are not alive) a) Name:


b) Relationship:
4. Address of Parent /Guardian and Telephone No. &
Email-

ID, if any

5. Educational Qualification of Parents a) Father:


b) Mother:
6. Occupation of Parent with Designation

7. Annual Income of Parent/Guardian from all


sources

C ACADEMIC DETAILS 99
A) Name of School where HSC is
completed

Name of Board for HSC

Year of Passing

HSC Marks & NEET CET 2016 Marks

Subject XII th marks NEET CET 2016 XIIth

i) PHYSICS English Marks -

ii) CHEMISTRY
iii) BIOLOGY

TOTAL

__________________

Signature of Student
Signature of Parent

D DOCUMENTS OF CANDIDATE
1. Documents to be submitted by the candidate

a) Admission form duly filled in Yes/No

b) Indian Nationality Certificate/ Domicile Certificate Yes/No

c) SSC Mark Sheet & Passing Certificate Yes/No

d) HSC Mark Sheet & Passing Certificate Yes/No

e ) NEET Exam 2016 Marksheet Yes/No

f) Leaving/Transfer/Migration Certificate Yes/No

g) Migration Certificate Yes/No

h) Medical Fitness Certificate Yes/No

(As per NEET Brochure )

i) Gap Certificate, if any Yes/No

j) Caste Certificate ,Caste Validity Certificate ,Non-Creamy Yes/No


Layer

(Applicable for reserved category students)

k) Birth Certificate Yes/No

l) Undertaking for fees on Rs.100 Stamp Paper duly signed Yes/No


before

the Notary

m) Undertaking for Anti ragging activity on Rs.100 stamp Yes/No


paper duly
signed before the Notary

n) Character Certificate issued by the Principal of last Yes/No


school/junior college

attended mentioning the status of his/her behavioural


pattern specially

in terms as to whether he/she has displayed persistent


violent or aggressive behaviour or any desire to harm
others.(As per provision made in clause 4 of Anti Ragging
Rules/Act.)

o) 4 Passport size Photographs. Yes/No

E Declaration to be signed by the Student & Parent

1. I have not been debarred from appearing at any examination held by any
Government constituted or statutory examination authority in India.
2. I fully understand that the allotment of a course will be made to me depending
on my inter se merit, order of Preference given by me and the number of seats
available at that point of time.
3. I understand that no documents after last date of submission will be entertained
for the purpose of claims or concessions etc. in connection with my admission
unless otherwise mentioned in the rules.

4. I am fully aware that the Competent Authority or its representative will not make
any correspondence with me regarding admission. I am also aware that it is
entirely my responsibility to see the notification in the newspaper and the
notices on the notice board of the college / website.

5. I am aware that any rule imposed by the university such as imposing limits on
the number of attempts permissible to pass any examination shall be binding on
me.

6. I hereby agree to confirm to any Rules, Acts and Laws enforced by Government
and I hereby undertake that, I will do nothing either inside or outside the college
which may result in disciplinary action against me under these rules, acts and
laws referred to.

7. I fully understand that the Principal of the college, has a right to expel me from
the college for any infringement of the rules of conducts and discipline
prescribed by the college or University or Government and the undertaking given
above.

8. Condition of minimum attendance: I am fully aware that, I will not be allowed to


appear for the examination if I do not attend minimum 75 % classes of theory,
Practical, drawing etc. I am also aware that I will not be allowed to appear for the
examination, if I fail to submit satisfactorily all the assignments, jobs, journals,
drawing, reports as specified by the university within stipulated time limit.

9. I hereby agree to pay the prescribed fees (inciuding Repeaters Fees) by due date
every year till completion of my studies . I also agree that I will not be admitted
to the next year nor I will be permitted to fill the Examination Form if I fail to
pay the tution fee by due date.

10.I shall keep the Attendance in the morning assembly/period meant for Student
activities Co-Ordination committee /Sports/ Any function / activities organized by
the College as part of my curricular activities and will attend the same.
11.I have read and understood the above clauses and hereby append my signature
by my own free will.

12.I further agree to submit to any action may entail cancellation of admission
rustication / expulsion and/or criminal prosecution (if necessary as per law)
------------------------- __________________

Signature of Parent Signature of the Student


Dean

Place :-___________________ Date:-______________

TERNA PUBLIC CHARITABLE TRUSTS

TERNA MEDICAL COLLEGE & HOSPITAL


Sector 12, Phase II, Nerul (W), Navi Mumbai 400 706,Maharashtra ,India
Ph.+ 022-27720563/ 27723664 / 27721442 Fax + 022- 27716314
E-mail :-terna_medical@yahoo.co.in website:-ternamedical.org
Date:- / /

Submission of the original & xerox documents - Ist MBBS 2016.

Name of the Student :-


_______________________________________________________________________

Address
:-______________________________________________________________________________

______________________________________________________Mob.no._______________________

To,

The Dean
Terna Medical College

Respected Madam /Sir

I the undersigned Mr./Miss_____________________________ hereby gives you letter

regarding following documents submitted in original & Xerox

a) Admission form duly filled in Yes/No

b) Indian Nationality Certificate/ Domicile Certificate Yes/No

d) SSC Mark Sheet & Passing Certificate Yes/No

d) HSC Mark Sheet & Passing Certificate Yes/No

e ) NEET 2016 Marksheet Yes/No

f) Leaving/Transfer/Migration Certificate Yes/No

g) Migration Certificate Yes/No

h) Medical Fitness Certificate Yes/No

i) Self student Gap Certificate, if any Yes/No

j) Caste Certificate ,Caste Validity Certificate ,Non-Creamylayer Yes/No


issued by appropriate

authorities of the Govt of Maharashtra where applicable

(Applicable for reserved category students)

k) Birth Certificate Yes/No

l) Undertaking for fees on Rs.100 Stamp Paper duly signed before Yes/No

the Notary

m) Undertaking for Anti ragging activity on Rs.100 stamp paper duly Yes/No

signed before the Notary

n) Character Certificate issued by the Principal of last school/junior Yes/No


college

attended mentioning the status of his/her behavioural pattern


specially

in terms as to whether he/she has displayed persistent violent or


aggressive behaviour or any desire to harm others.(As per
provision

made in clause 4 of Anti Ragging Rules/Act.)

o) 4 Passport size Photographs. Yes/No

Sign Of student -
TERNA PUBLIC CHARITABLE TRUSTS
TERNA MEDICAL COLLEGE & HOSPITAL
Sector 12, Phase II, Nerul (W), Navi Mumbai 400 706,Maharashtra ,India
Ph.+ 022-27720563/ 27723664 / 27721442 Fax + 022- 27716314
E-mail :-terna_medical@yahoo.co.in website:-ternamedical.org

Date:- / /

APPLICATION FOR :- Submitted DD Rs.2020/- for Amartya Shiksha Yojana

Name of the Student :- _____________________________________________________

Class :-__________________________Tel .No /Mob._______________________

Address :-___________________________________________________________

___________________________________________________________

To,

The Dean

Terna Medical College

Nerul,Navi Mumbai

Respected Sir,

I the undersigned Mr./Miss__________________________________________ hereby gives

you Amartya Shiksha Yojana Insurance Scheme - Rs. 2020/-


for Ist Year

MBBS Course 2016-17 .

(To be paid by D.D. favour of National Insurance Co. Ltd.Payable at Kolhapur.)


Name of the Father/ Mother :-_________________________________

Date of Birth Father :-_________________________________

Date of Birth Mother :-_________________________________

Thanking You.

Yours faithfully

Student