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JSSU MBBS Application Form

This document provides information and instructions for applying to the MBBS course at JSS University in Mysore, India. It includes an application form requesting details about the applicant's education history, marks obtained, and contact information. The form must be submitted along with supporting documents, a passport photograph, and a processing fee. Incomplete applications that do not include all required documents and information will not be considered.

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AnweshaBose
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872 views4 pages

JSSU MBBS Application Form

This document provides information and instructions for applying to the MBBS course at JSS University in Mysore, India. It includes an application form requesting details about the applicant's education history, marks obtained, and contact information. The form must be submitted along with supporting documents, a passport photograph, and a processing fee. Incomplete applications that do not include all required documents and information will not be considered.

Uploaded by

AnweshaBose
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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ANNEXURE - I

JSS JS S UNIVERSITY
(Established under Section 3 of the UGC Act 1956) JSS Medical Institutions Campus Sri Shivarathreeshwara Nagara, Mysore 570 015, Karnataka Phone: +91-821-25483400/93 ; Fax No.+91-821-2548394Web: www.jssuni.edu.org : [email protected]

APPLICATION FOR ADMISSION TO MBBS COURSE


Incomplete Applications will be rejected

Passport size Photograph attested by the Dean/Principal/ Gazetted officer


COMED K UGET 2014 Test Score COMED K Application No COMED K TAT No COMED K Rank

Candidate Details (ALL THE ENTRIES IN THE FORM SHOULD BE IN CAPITAL LETTERS ONLY) 1.Candidate's given in class SSLC/10th 1.Candidate's Name :(As : Certificate) 2. Father's/Mother's Name : 3. Gender : 4. Date Of Birth : 5. Caste Caste / community : (The certificate should be enclosed) GMGMMale Female

Day

Month

Year

OBCOBC-

SCSC-

STST-

6. Address for Communication:

CITY PIN : DISTRICT STATE

7. EE-Mail : 8. Telephones : (STD Code)- (Telephone No.) Mobile No. 9. Details of Demand Draft : D. D. No. Amount in Rs. Date Of Issue Name of Drawee Bank 10. 10. Details of Education : Name of Board / University Name of College Month/Year of Passing : (10+2) / PUC

Rs. 2,000/2,000/-

Day

Month

Year

11. Please enter the percentage of Marks scored in Qualifying exam( Please don't enter % Symbol)

Name of the Exam Passed Board / University

Year of Passing

Class obtained & attempt of passing

Medium of instruction

% of marks obtained in aggregate of all subjects

SSLC/ SSLC/ * Equivalent 10+2 / PUC / * Equivalent

Any Other

2|Page JSS UNIVERSITY, MYSORE.

12. Please enter the of Marks scored and percentage in Qualifying exam( Please don't enter % Symbol)
Subjects Physics Chemistry Biology English Maximum Marks Obtained Score %of marks
PCB aggregate %

DECLARATION BY THE CANDIDATE


1. I, Mr. / Ms. hereby affirm that the information furnished by me in this application and the enclosures is true. I know that if the information furnished by me is untrue, my seat will be forfeited. 2. I will not indulge in any form of ragging. I know it is a criminal offence and if found guilty, I will be summarily dismissed. I undertake to make good the loss caused to the college/staff/student or any other person caused by any illegal act of mine. 3. I am liable to pay the balance of fees calculated for the entire course, in case I discontinue the course or I am expelled from the college for any reason. 4. I shall abide by all the rules and regulations of the college that may be framed from time to time. 5. In all matters regarding my admission to UG course, the decision of the college is final and binding on me.
Left Thumb Impression of the applicant.

Place: Date:. Signature of the applicant

DECLARATION BY PARENT OR GUARDIAN


1. I, Mr. /Ms hereby affirm that the information furnished in my Sons /Daughters /Wards application and in the enclosures is true, I know that if the information furnished by my Son / Daughter / Ward is found to be untrue, my Sons/Daughters/Wards seat will be forfeited. 2. I know ragging is a criminal offence and shall take steps to prevent my Son/Daughter/Ward from indulging in it. I also know that if he / she is found guilty of the offence, he/she will be summarily dismissed from the college. I undertake to make good the loss caused to the college /staff/student or any other person caused by any illegal act of my Son/Daughter/Ward. 3. I am liable for payment of the balance of fees calculated for entire course, in case my Son/Daughter/Ward discontinues the course or is expelled from the college for any reason. 4. I am also aware that once the candidate is admitted to the course, no refund of fees either in full or part there of will be made, for any reason. Place: Date: Signature of Parent / Guardian

(Declaration to be signed by the Guardian, only in case of both father & mother of the candidate being not present)

3|Page JSS UNIVERSITY, MYSORE.

LIST OF ENCLOSURES TO ACCOMPANY THE APPLICATION FORM:


Processing fee of Rs. 2,000/- only by way of DD favouring JSS University Fee Account, Mysore, payable at Mysore along with the documents listed below.

* Attested copies of the following documents have to be enclosed along with

the application form and kindly arrange the documents in the following order.
1. COMED K - UGET 2014 Score 2. COMED K - UGET 2014 Rank card 3. COMED K - UGET 2014 Test Admission Ticket (TAT)

4. S.S.L.C./Equivalent examination marks card. 5. P.U.C./Equivalent examination marks card / Proof of having appeared the

PUC II / 10+2 / HSC or equivalent examination. B.Sc.,/Equivalent examination all


the three years marks cards (in case of graduates) 6. Conduct/Character and Transfer certificate issued by the college last studied. 7. Date of birth certificate if not mentioned in the SSLC/Equivalent examination marks card. 8. Caste / community certificate.(The certificate issued by competent authority) 9. Transfer certificate for Karnataka board candidates. 10. Migration Certificate issued by the Board /University in case of candidates coming from outside Karnataka State. 11. Six recent, identical passport-size colour photographs with name and date.( In addition one copy of the photo should be pasted on the application form in the space provided)

12. Self addressed 3 nos. envelops. ( Size = 10.5 X 4.5 OR 9.5 X 4.5)
13. Foreign Nationals seeking admission should obtain eligibility certificate issued by JSS University, Mysore.

Note: The prospective candidates are directed to enclose the copy of COMED K UGET 2014 entrance test score, Rank, TAT card and above mentioned documents along with application before sending to the University office for registration. Incomplete application will not be processed.
4|Page JSS UNIVERSITY, MYSORE.

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