KEMPEGOWDA INSTITUTE OF MEDICAL SCIENCES

CHECKLIST FOR ADMISSION TO FIRST MBBS

ESSENTIAL DOCUMENTS TO BE SUBMITTED AT THE TIME OF ADMISSION

1. Original 10​th​ & 12​th​ Marks card.

2. Original SC/ ST/ OBC/ Income/ Rural / Hyderabad Karnataka/ any other
relevant Certificate.
3. Original Transfer Certificate, Migration Certificate.
4. KEA allotment letter and NEET Rank Card.
5. Fees Paid Receipt/ Bank Challans from KEA.
6. Eligibility Certificate issued by RGUHS for Students other than Karnataka
PUE Board.
7. 5 Color Passport Size Photographs.
8. ID Proof- Aadhar Card/Voter ID/ Driving License/Passport.
9. Pan Card Copies of Parents​.
10. Rs 100 E-Stamp Paper for Rural Bond.

ADDITIONAL DOCUMENTS FOR MANAGEMENT CATEGORY/ NRI STUDENTS

1. Passport & VISA Copies.

2. Registration Certificate and Residential Permit issued by FRO.
3. No Objection Certificated from Government of India.
4. Passport & VISA of the sponsors.
5. Rs.100 E-Stamp Paper for undertaking bond.
6. Bank Guarantee or 4 post dated cheques for fee of remaining 3​1\2 ​ should be
submitted.
​ All the above documents- 3 sets( Photocopies) to be submitted at the time of
admission.

UNDERTAKING (Rs. 100-Bond Paper) 

I,………………………………………………………………………………………………………… S/o D/o of 
Residing at ………………………………………………………………………………………………............. 
…………………………………………………………………………………………………………………………. 
Mobile Number ……………………………………………. Email-Id ………………………………………… 
 
I  have  been  allotted  MBBS  seat  at  KIMS,  Bengaluru  for  the  1st​   MBBS under NRI/Management 
for the academic year 2019-20. 
 
Further  I  declare  that  college  fees  of  31/2
​   ​years  amount  will  be  paid  according  to  KEA 
instructions  by  submitting  Bank  Guarantee  on  or  before  Fifteen  days  as  per  the  guidelines  of 
Government of Karnataka. 
 
I  am solely responsible for submission of the Bank Guarantee for the 31/2 ​   years. In case I fail to 
submit  the  Bank  Guarantee  my  seat  may  be  cancelled  as  per  the  guidelines  of  Government of 
Karnataka. 
 
Till  the  time  I  submit  Bank  Guarantee,  I  will  give  4  post-dated  cheques  at  the  time  of 
commencement of classes. 

Cheque No.:    Amount: 

 

Signature of the student Signature of Parent 

 ANNEXURE – 9

EXECUTION OF BOND BY CANDIDATE WHO SELECTS MBBS SEAT IN MEDICAL COLLEGES OF KARNATAKA
(On Rs.100/- e-Stamp Paper)

I,Mr/Kum………………………………….S/o./ D/o …………………………………………………….

candidate with UGNEET 2019 Roll No …………………… and residing at

………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
………………………………………………………………………………………………have on my
own volition allotted a MBBS seat on………………………….. in …….……….………………
…………………………………………………………………………………………vide admission order

number ……………………………….dated …………………………………….. and do hereby

undertake as follows.

In accordance with the Amendment to Rule 11 of the Karnataka Selection of Candidates for Admission
to MBBS seats in Professional Educational Institution Rules, 2006, vide Government Notification -1 No.
HFW 79 RGU 2011 dated 17-07-2017 and Amendment act 2017 dated 06-07-2017 I am prepared on
completion of the course to serve in any Primary Health Center or Primary Health unit situated in Rural
Areas in the state of Karnataka for a minimum period of ONE year and I will abide to rules and regulation
of Government of Karnataka.

What is stated above is true and correct and I and my parent/ Guardian hereby undertake to act
accordingly.

Signature of the Candidate. Signature of the Parent

(Father / Mother)
Date:…………………..

Place…………………..

Witness:

1.

2.