Eligibility Form

Page 1 of 4
NEPAL MEDICAL COUNCIL Recent Passport

Size coloured
photo.Not more
Bansbari, Kathmandu, Nepal than 6 months
old.
Application Form for Eligibility Certificate for
Undergraduate Medical Course in Foreign Medical Institution

PERSONAL DATA
Surname: y/ M
First Name: klxnf] gfdM
Middle Name: aLrsf] gfd M
Fathers/ Mothers Name:
Sex : Male Female Others
Date of Birth: A.D B.S. ..

[dd/mm/yyyy] [dd/mm/yyyy]
Citizenship No. ..
Place of issue:
Date of issue:..
[dd/mm/yyyy]
Passport No. .. Place of issue
Date of issue:..
[dd/mm/yyyy]
Email Address:
PERMANENT ADDRESS:
Place: . .. Municipality/VDC .
Ward no: .. District:
Zone: Country: .
Contact phone number: Mobile number:.......
LOCAL ADDRESS :
Place: . .. Municipality/VDC .
Ward no: .. District:
Zone: Country: .
Contact phone number: Mobile number:...

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NEPAL MEDICAL COUNCIL

Bansbari, Kathmandu, Nepal
1. ENROLLMENT APPLICATION DETAILS:
a) Degree/Course :
b) Details of Institution:
Institution Name:
Institution address:
Website:
E-mail: .
University: ..
Country: Duration of the course:
From: . To: .
c) Medium of instruction: ..
d) Whether college is recognized by
concerned medical council /Government YES/NO
e) Whether candidate will carry out

Internship in the same Country YES/NO
2. EDUCATIONAL QUALIFICATIONS:
i. High school/10+2/I.Sc/CBSE/ Equivalent
a) Institution /College Details
Institution Name: Subjects Marks Marks %
Total Obtained

Physics
Institution Address:.
Chemistry
Country:.
Biology
Board:.. PCB Total
b) Duration:
Date of Joining: Date of Completion:
c) College Registration no: .
d) Percentage/GPA: ..
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ii) School Leaving Certificate
a) Institution Details
Institution Name: S.N. Subject with Marks Marks Percentage
Top 5 Marks Total Obtained (%)
..
1
Institution Address: 2
.. 3
4
Country: . 5
b) Duration:
Date of Joining: . Date of Completion:
c) School Registration no: d) Percentage/GPA:
4. DETAILS OF VOUCHER:
Name of issuing Bank :
Amount Rs.: Voucher No.:. Date:.
CHECKLIST: for application of eligibility for Undergraduate Studies in foreign

Institutions
S.No Contents Yes No
1. Completely filled eligibility (criteria) form

2. Copy of Offer Letter/Confirmation letter from foreign Institution
3. Attested Copy of citizenship
4. Attested Copy of Character Certificate and School Leaving Certificate
/Equivalent
5. Attested Copy of Character Certificate and I.Sc/+2Certificate/Equivalent
6. Bank voucher of a one-time fee of NRs.1000
7. Passport size photos-3 copies
INSTRUCTIONS:
1. A Candidate must have passed 10+2 or equivalent qualification recognized by Universities/Board
with Physics, Chemistry, Biology (PCB) and having passed in each subject securing a minimum of
50% in PCB and also in aggregate .
2. Applicants are required compulsorily to come themselves for the Eligibility Application with valid
ID Card.
3. All documents need to be attested by the Notary public.
4. GPA Score should not be less than 8 for students going to study in Bangladesh.
Date of submission: Signature:

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BOND
The Registrar,
Nepal Medical Council
I ............................................................... resident of is going

abroad to study at least four-and-a-half years graduate in medicine/dentistry [ MBBS/BDS/MD
(equivalent to MBBS) ] under the modern medicine system. I will continue my study in the same
college till I will finish my one-year internship.
I am aware of the provision that I will be eligible for temporary registration only after passing
Licensing Examination conducted by Nepal Medical Council.
If the documents and details which I have submitted turn out to be false I will be responsible for
it and be ready to face any consequences as per Nepal Medical Council rules or rule of the
Country.
Candidate signature: ..
Date: . Right Thumb Left Thumb
__________________________________________________________________
FOR OFFICIAL USE ONLY
Received By: Verified By:

Signature: Signature:
Date: Date:
Special Instructions (If any):

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Page 1 of 4

NEPAL MEDICAL COUNCIL Recent Passport

Undergraduate Medical Course in Foreign Medical Institution

First Name: klxnf] gfdM

Middle Name: aLrsf] gfd M

Fathers/ Mothers Name:

Sex : Male Female Others

Date of Birth: A.D B.S. ..

Ward no: .. District:

Contact phone number: Mobile number:.......

Ward no: .. District:

Contact phone number: Mobile number:...

NEPAL MEDICAL COUNCIL

Country: Duration of the course:

e) Whether candidate will carry out

Date of Joining: Date of Completion:

c) College Registration no: .

NEPAL MEDICAL COUNCIL

Name of issuing Bank :

Amount Rs.: Voucher No.:. Date:.

CHECKLIST: for application of eligibility for Undergraduate Studies in foreign

1. Completely filled eligibility (criteria) form

Date of submission: Signature:

NEPAL MEDICAL COUNCIL

I ............................................................... resident of is going

Date: . Right Thumb Left Thumb

Received By: Verified By:

Special Instructions (If any):

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