#s
-E osE/36 ig-ogd
egdperls d;d: d;e.r:oa dero5m dedrid uoJ:cqe;oir,
v
esd-taerfu dad, drorJ6 d{, a3oridod;-o6oo2s.
ulodaoe8:oao-2329551o e-dJeeJ6:spm becka [email protected]
Joald: 23q.$/aae l2O2l2021 -22 6uood: tJ. tL2o22
droaiuo dd
.5doi: 2o22-23d€ dJdedd ;roesri dedosdd uodmd6 ddrd6
d6rro56roorldd.6 oaodEoeQd uo6dorl{ (N E ET-PG) &olraeeed)d
a:fl.
2o22-23iJe uoegrl deaoodd ar.,-aa ouuO*regid doddor,d ,t,eL]) eeolS dJaadJadgd
deda&dd d6d6d:ridc BeroaJo$ der6Jdrr6 https://ka ru nad u. karnataka.gov. inlhfw de dd.o,scbdod
dro.soo/- rid dlo a,od: $d6ed a:odd$ 6-0r1la drd.too/-rld d::ala3e3oJ: oddr {d5ed
aiejo3.>
aoddgddila d.i.,osueeo6 61 dJQ ll d Jodoeor ddQrloddr4 dd)$d ls, rso d)e daog
a:o{d$rid drodo ee$d.ir.J6 d.son^bd abQ arodd$ d*rad Ogoi$d {doderon&Qd. eoddod
eoid) uod do8eee,3, do{ oodd$riddrd a,dRdo toar,$d.
r. aoddgrid.bd a)oeod)ddri 1de uoLsr er+l66roJ: dd& *q 2de a-o$r HFW
Government of Karnataka (er$d d arrJd drord) oodJ dd.ro6,$cbdod aodddriddr,c
ddobddJ
2. aoddEr,ddrd &edJdori ddJJod ted a:oddgdgdrQ doag a:o{d$dg ddrooabd
d-B draEriddJd uo"ddoegid dda/Gd8edro abq 6")d6o ,$e6D etoi3
dro6d$o6dJddd: esd0r3 eo$onuorbd dodd doQdd:. aba$ dd:.:a6dded:.
s. aoddgrid$a dgdoaori dlade.ld dgo-oduon Joa:oddg ddddd ddd&d o-arlo oddde
dErddoon esd;aer{g dJq do.d. JedrJdo dararard du-osd. aiorldod: aod:
d*Jaodd{Eb.
4. eroddgdg uo"ddrae{d dd.r/6.t8edro d:Q 6ao6as ao5dorid dodd 10 ddr ded
dgdoO.ron ddrra6irrdd: draoJ:arondo{d. a.ocJ: ded 10 ddE ded dgdde e{g
adgedra oddori &dE&dDddori d.ro. 25.oo.ooo/- e.:{ doa-ocoriC dod a-orlo
ua*dd-oeQd dde daddorJ &dr&dDddori dn. so,oo,ooo/- oli d.Ddao$rjd dod
aQJe-rorbdd:. ddO dodd d.od ddoesrro0 eodd6dd dodra;ocJg
Ed ererjd dreeJ
diroa dnd;d Joa:od ddO ddddd draq dJacr5oJl:{ er,$doduonde3e* EddrrJCJ d;jJd
8-q"i, 6ooeJ/JeeJ66ec6/ara6o dooool) {d:oeo d$ rorto Edde dra&oobg dono
d66edrd dudq dgon$a dqo$ron dgan{dc a,od.: ded d:eesdod dod a-odoJde
a€E dradodon doddes ddo ddddori 2 doetoemo d)* @o.gd) d,detred
sederorbddJ. ddo drae$e.$ri doodde e€g pde doddes es-o.i|)enbcrodori 2 droetsero6
drq eeo.oil doeeoe-" oaO droderorb{ujJ. 3de doddg d6d5d: .id) ec-oaredJ.rodd
esQoj:d:" d::Lr.:droeoJ rosdood:. dodd doQddc* ddroe drode)) u-adrdd)
ddJddriragerorfrd)d: aorto ddddd d.io.rJ d-oeodedoiab. dd;rlouder: ddd) -3o6-od{
6+odQ dmderorbd;d:.
o. aroaJedro-ado-an J& dDdddd:. a,g dearoedd oaoddoe$d ddddori drdE d& drodd
ddgriJaddB&qd. eg-oa:edcoodoon d& dDcbdddJ erodasgd Jd:ed aodd$dg
ejcrdo6 rac566/ei.J-adrro rbd:Od aret.g/oodd a;ood dduadn/oosodrdeoerd doa35oi:d:"
dd)rd6,$ d& drd6dJdd. eeeacF 6acr6r/dr adsro rb&Od agetc/aadd -arood
dd odn/do 6drdeo6r gioJ:o dr6edrd doo{ d8o$dr.l doBo$ardn dgde3edc.
6. esaaredr sed:ddrjo croa5Zdeo{ du'orO dadddo qdde deddoodoan{d doa:oddg
do{or;od dr6edrd dedd ddyoro dEdrao6ri oof,d$r'idd:o desde! draarderand.
z. deaondd uo.dd-oe$d dddd aood6rddo ar"dargd d$ed dild deeo6 doald 6-orLa
eraa)ed).rodd) ooa6 dtrorO daddqdn€g desec6 dooldoiabu o-orlo eeqod dodt
JoaJ6oJ.:d:n dqo$ron oeA (drJodJ) arodd$dg d*ro6dod6b.
T\
-2-
a. d orrJd doero a36aodddd drddod d:Q oddd dogd da&oorf dgor:ong
qrorjd&,$ de-ro&dd d6d6d:ridc €eogd)don edro,$ ddd ,$e€.! d)q edodooJ
eroigon dodd drordd egdeddd.:uod dlee.:od arodd$rldd:a dogondon aD*
doesuoR *gtO{dj. ooddEridJ gilodaron Jgdde e{g dde d66od ad:rJd drader:
eedrdJ€ dE oeder) epdaadadroag.
9. ddd dmd; ddrridg rqdori{ eeototrdn daddorl &draoab€drd dedoedd dddddr,d.)
erda)ed).rodoan d& drodJdoeE. ?o? dedo&dd uooddoeQd d6d5d:riuri
erda)edrdodoon Ssc drdo dd dodd af;A4gOri dd es-oaJe bcraduon d& droadg ee
e?d: dddddJrid a;oddgdaba dodrdd:d6g rarko ec oddJa a:ot'd$rldc
ed{rdrrodg$d
10. d6oFdd &o}oeaJd egded ddd; uo6dori{ ooa<rod dddd&rldo, ao5dori{ a-aacrad &og,t,
d€dd&n 3 oddjadrDn eso3:rqoo3:{ dr:o3o dgdo djaa,$d. d*dg s*d dedd
d){
dddrid.nd ddoj:o: drod6$d dO &oloeanro erdeddd:a dod6do)
edoouoridd. ddo sdoad eede ded dJardrrddoondJoeo.
11. erobo}ad d6d6d; a:odd$dg ddo,$ oe9do6 doajd arorkd erqoo5 -06"r doaidoiabd
dqo$dan dil.,a6deJedr.
12. eroSJojrod d3d6d; a:oddldg oot draadrood adoi. u-oeJee,: d:Q du-ordOod
eroldood a:rl d.od6de-rad erded JoaJ6 dcQ 6uooddd:" d6goniloo ddlro6abdd).
1s. eroddsi 19, 19o d:Q dang aroo66 dJ-dj e+de€J6d)d oq eorl_d5 dro&OrlCdrd
$dca{ron ddrrd6,$ doea:Oddd d66eddeod.oo6ri doa:oddg ddddcb dqona-dn
eJoddE{oed eararig Nq 6-oacron dgdd{d;.
t+. !.do. 1 Ood ledddnd oen eoodriddto dOAeee,E !aba:{a-on anaq drd&o aorto errid5
doarerd€ddRbd tudn,$ ddrd66od a:d:rld d.oodo: odrdra dg ddobd)cn
do3oluond.:Qd. ooddEd&d jd:a:{a-an dgd6€g adrrid dooder: aorlo sd:dro
d$dd:n ddoJ:er: €rdroancb{og.
* dceood ae3 eoodridd:" du3&r-Bn uoedcdod d:Q eodrld5uan deieOoll de.:Sriur3
oQdaddod. gdJd&du d,oar,$d.
EJ &, 13.,2.u -
edoer| d;dJ d:.d Jedridc
dooidr:-
o$1"aa^a,.y-
ae4 erdoerfu d:d: d:.d.erQ-o0rldc/
eee* dEiatEgd$, aiorid,od; dridr
doriCrodc rEJlaodd/ a: gdJrls /oodorld/
do e erod I ddofl / a, { a sB&d /rd ildrj d /
Z
d:drd;o&/ &ddJodJi a3 *drrl6tia&/d:odd/
aboridJadJ(d.d)/e.ro; jcooadridld.ndrb/6-0dd/
vud:a/dCroa/arariodloeeJ/.iarojldJd/a-od.rod/ridri/
dodeo/6od-od(eD.d. )ard€ee eodd egl. dooJdR/aDdC/
ae e d06 / o rlo 0 / a ao$d rid qooJ:dndJ / olrodn 0 /
Z
raodcaoe-:d:. -- ddeJeo deod
* i<' *o*d - ' *- eo6eddd;.
eseJ/d.d"Eeoi prlic
-- --- "'.:J'
-------2eg/dd&dredddJ,
&0o$ dooi6 gdroa6a0ddc. riodoi:o$ a4rari. erdraerls d>d; douuoa deru6o dedrlC
&dEed ooo$. dorJd"od: ed6ri drasJ:so * drd&.aoidJd * d.odeJe eeraaioi eoodreroodg
{dosJo.) d,oa3,$d.
IroR\I -19
BOND TO BE EXECUI'ED BY A GOVERIIIMEN'I'SEI{VANT PROCEEDING
ON DEPUTATION TO II IGHEIT STUDIES/SPtrCIALIZED TRAINING
I S/o / D/o resident of- -. ...... .- -.. - ol
in the district ol ... at present
working as Medical otficer in the department of Health and
family welfare (hereinafter called "the obligor")
AND
(;L:,-\ltAN'l Ol{ / St.Itl'.T'
I S/o / D/o of........ of
and ..sor/daughter of of
I ......... ... .. .. .. .... .. S/o / D/o ol
........ (hereinafter called "the
sureties") do hereby .jointly and severally bind ourselves and our respective heirs,
executors and administrators to pay the Governor of Karnataka (hereinafter called the
Government) on demand the sum of Rs.50,00,000/- (Fifty Lakhs only) for PG Degree
Rs. 25,00,000/- (Twenry Five Lakhs only) for PG Diploma together with pay and
allowances, daily allowances, stipend with interest thereon from the date of demand at
Govemment rates lor the tinre being in fbrce on Governnent loans. And together with
all costs between attorney and client and all charges and expenses that shall or may
have been incurred by the Government.
WHEREAS, the obligor is granted deputation to higher studies/specialized training by
Govemment.
WHEREAS lor the better protection ol the Government, the obligor has agreed to
execute this bond with such condition as here under written.
WHEREAS. Dr.. and
Dr... . ... .. . .. . ... .. ...sureties have agreed to execute this Bond as on
behalf of the above bounden Dr
NOW. THE CONDITION OF THE ABOVE WRITTEN OBLIGATION IS TFIAT in
the event of the obtigor Dr.......................... I'ailing to resume duty or resigning
trom service or otherwise quitting service without returning to duty after the expiry of
termination of the period of deputation or at any time within a period TEN years after
his return to duty, the obligor and the sureties shall forthwith pay to the Govemment
or as may be directed by the Government on demand the said sum of Rs. 50'00'000/-
(Fifty l-akhs only) lor PG Degree Rs. 25,00,0001 (Twenry Five Lakhs only) for PG
Diploma together with pay and allorvances. daily allowances, stipend, tuition fees,
etc., with interest thereon from the date of demand, at Government rates
for the time
being in force for Govemment loans.
It shall be lawful to the Government to nrake recovery of the amount (including pay
and allorvance, stipend. daily allowances. tuition fbe' etc) spent on higher
studies/specialized training lrom the salary of the obligor in case the competent
in the
authority comes to the conclusion that he/she has not shown sufficient progress
studiesorhadfailedtocompletethecourseinpropertime'asMClnormsfuniversity
regulations. In case it is not possible to recover from the salary, the obligor and the
sureties herervith agree that they shall be jointly and severally liable for the repayment
of tull amount of expenditure incurred by the Government. The obligor has taken an
admission under atbresaid rules 2006 the obligor thiling to to resume duty or resigning
fronrservicesorotherwisequittingservicewithoutreturningtodutyaftertheexpiry
ol termination of the period of deputation or at any time within a period TEN years
after his return to duty. the obligor and the sureties shall forthwith pay to the
sum of
Govemment or as may be directed by the Govemment on demand the said
Rs.50.00.000|(FitiyLakhsonly)fbrPGDegreeRs.25.00'000/.(TwentyFiveLakhs
only ) tbr PG Diploma together rvith pay and allorvances, daily
allowances' stipend'
tuition fees. etc., with interest thereon liom the date of demand, at Goverffnent
rates
for the time being in force tbr Government loans'
And upon the obligor Dr... ...... ... ... ... " "and ' '" '""''"' "Surety (l)
and ..,....................Surety (2). the sureties atbresaid making such payment'
the
above wrinen obligation shall be void and of no effect, otherwise, it shall
be and
remain in full force and virtue:
Provided alrvays that the liability of the sureties, hereunder shall not be
impaired or discharged by reason of time being granted or by any forbearance' act or
(whether with or
omission of the Government or any person. authorized by them
rvithout the consent or knou,ledge of the sureties) nor. shall it be necessary for the
Govemment to sue the obligor belore suing the sureties
.....and.......................or any ol them for the amounts due here
under.
The bond shall in all respects be governor by the laws of India for the time being
in tbrce and the rights of liabilities here under shall where necessary be accordingly
determined by the appropriate couIts ollndia.
The Government of Karnataka have agreed to bear the stamp duty payable this
bond.
Signature olthe obligor,
Signed and delivered by the obligor above named Dr .......in presence of
witness hereunder:-
WITNESSES: (Signature with Address)
l. ................
Pa ssn n rt
2
Passport
Photo
Signature of the Surety (1)
Aadhar are Voters ID Numbers
l) Dr............. .Signed and delivered by the delivered by the obligor
above named Dr............ ...... ....in presence of witnesses hereunder:-
WITNESSES:
I
Passport
Photo
)
Passport
Photo
Signature ol the Surety (2)
Aadhar are Voters ID Numbers
Signed and delivered by the delivered by the obligor
above nanred Dr. .in presence ol witnesses hereunder:-
WITNESSES:
i
Passport
Photo
Passport
Photo
SWORN BEFORE ME
VERIFIED AND MAY Btr ACCEPTED
COMMISSIONERATE OF HEALTH AND FAMILY WELFARE SERVICES,
BANGALURU 23.
Accepted
Principal Secretary to the Govemment
Health and Family Welfare Department
The guarantor can onll- sign a bachclor's master's Stamp paper value not less than
physician, but the bachelor's degrec physician cannot Rs. l00l Get the Notary
signature & seal.
sign each other's docunrents for guarantee.
FORM -I9A,
I aged. S/o
presently working as medical offlcer .......... ...................... In
the departnrent of health and f-arnil-v welfare do hereby solemnly affirm and state on
oath as lbllows:-
ln responses to my application fbr PG Medical seat, govt. of Kamataka has
allotted me a seat, in (subject)
Govt ordel no.. Dated: .while allowing action to the
selected candidate either to join or not to .ioin the course. The Govt of Kamataka have
directed that anv person taking put the higher studies tbr more than once after entering
into the govt. service shall have to pursue higher studies being on study leave for the
duration of course. Covt. of Karnataka in exercise on their discretionary power under
rule 7 olappendix -ll A-l of KCSR have directed that only persons taking up higher
studies for the first time after entering Govt. service shall be entitled in appendix-ll of
KCSR. The Govt. have also directed that those taking up higher studies for more than
once in Govt. service to submit their study leave application in form No-l or KCSR in
triplicate betbre thel' are relieved of their duties to.ioin the course to which they are
selected and others who are taking up the higher studies to the first time should
execute affidavit to the effect that they are taking up higher studies for the first time
after entering the Govt. service.
Noii'. thelefbre. I Dr'. S/o
swear on oath and l.rereby solen.rnly affln]l state that is the llrst time I am taking up
higher studies after entering into the service of Govt. of Karnataka. I have not been
deputed by Govt. of Kamataka for any higher study so far in my service.
I
understand that if the declaration made as per this affidavit is found to be
incorrect or talse nol only I shall be tiable for legal action but also 1o the departmental
disciplinary action. besides tbrtbiting the seat allotted to me as per becoming liable to
repay the Govt. of Kamataka all the expenses incurred by it on me in regard and the
interest thereon at the highest late prevailing in Govt. and also to pay the legal
expenses ifany that may have to be incurred by the Govt. of Kamataka.
Place:
Deponent
Date:
Dr........
Sworn before me
l) Dr............. Signed and delivered by the delivered by the
obligor above named Dr . .............in presence ol rvitnesses hereunder:-
SURITY: (Signature with Name and Full Address)
Aadhar Voter lD KCID
No No Metal No Passport
Photo
Aadhar Voter ID KGID
No No Metal No Passport
Photo
2) Dr............. .Signed and delivered by the delivered by the obligor
abovenanredDr......................inpresenceofrvitnesseshereunder:-
WI'I'NESSES:
I
Passport
P hoto
2 Passport
Photo
SWORN BEFOREME
Verified and may be accepted
COMMISSIONERATE OF HEALTH AND FAMILY WELFARE SERVICES,
BANGALURU _ 23.
Accepted
Principal Secretary to the Govemment
Health and Family Welfare Department
The Guarantor can only sign a bachelor's master's Starnp paper value not less than
physician, but the bachelor's degree physician cannot Rs. 100/- Get the Notary
signature & seal
sign each other's documents for guarantee.
Pass port
Photo
NOTE: STAMP DUTY PAYABLE BY THE ISI PARTY IN FAVOUR OF 2ND PARTY
HFW. GOVERNMENT OF KARNATAKA (FOR ALL EACH BOND)
l" Party, Candidate Name
2"d Party. HFW. Govemment of Kamataka (For all each bond)
PENALTY BOND
know all men these presents I Dr.............. . ... .. . Aged,... ...years,
Sio presently working as Medical officer... . ..........................in
the Departnrent of Health and tamill. rvelfare hereinaller called the obligor and
Dr ....(hereinafier called the surety) do jointly and severally
bind ourselves and our respective heirs. executors and administrators, to pay the
Governor of Karnataka (hereinafiel called the Government) on demand of sum of
Rs.5,
00,000/- lor degree & Rs.2,50,000/- for diploma tosether with oav and
rrllotvances, loily ollowurrces, stioend. tuition fees, elc., ruith inlerest thereon lrorr
the date of demand of Govt. rates lor the time being in fbrce of Govt. loans and along
u,ith all costs betrveen attorney and client and expenses shall or any have been
incurred by Covernnrent.
WHEREAS the obligor is taken a seat under THE NATIONAL BOARD OF
EXAMINATIONS NEET conducl of Entrance Test lor selection and admission to
Post Graduate Medical and Dental Degree and Diploma Courses Rules 2006 to pursue
higher studies by Governnrent. and rvhereas for the better protection of the
Government. the obligor has agreed to execute this Penalty bond with such conditions
hereunder rvritten. The obligor has agreed that in case of an in-service candidate fails
to resume duty in Health and Family Welfare Department's Hospital/Centre even after
the expiry of termination of the period of deputation or at any time within a period of
TEN years afler completion ol higher studies, it shall be lawful to the Govemment to
make re-convey ofthe amount spent on higher studies including pay and allowances,
stipend, daily allorvances, tuition t-ees, etc.. with interest thereon from the date of
demand of Govl. rates for the time being in lbrce of Govt. loans. It is as per Rule- I 5
ofPGET Rules 2006.
And rvhereas. the atbresaid sureties have agreed to execute this bond sureties on
behalf of above bounded Dr ... Norv the condition ofthe above rvritten
obligation is that in the event ofthe obligor Dr... ... ...... ...... .......leaving the course
the obligor and the surety shall tbrth with pay to the Govemment or as may be
directed by the Government on demand the sum ofRs. 5.00'000/- (Five Lakhs only) in
case ol PG degree Rs.2.50'000/- (Trvo Lakhs Fiftl' Tl.rousand only) in case of PG
dip lo t11L\ together wilh Dqt ond ullowonces, doilv ollotronces, stipend, l,tition fees,
etc. b,ilh interest lhercon tl'on.r the date ol'demand at Government rates ol the time
being in tbrce on Government loans as a penalty and also t he obligor is liable to
debaned liorn applying to PG course for the next ttuee years, in the event of leaving
the course. before its completion.
It shall be lar.vful to the Govt. to make the recovery of the amount Rs.5,00,0001 in
case ot'PG degree Rs. 2.50.000/- in case of PG diploma from the obligor
the surety
shall be iointly'and severally liable to pay sum of
Rs'
tosether with
5.00.000)- in case ol pG disree Rs. Z.SO.OOOI- in case of PG diploma
Dot' nd 0llo rloilt'olloxunces, stiDend, luilion fees, etc., wilh interest
lhereon as a penal!v and obligor to be debarred tiom applying to the pG course for the
next th-ree years.
And upon the obligor Dr...........................and Dr... ... ...... .......surety (1)
and Dr.......... ... surety (2), the sureties aloresaid making such
payment the above rvritten obligation shall be vide and of no effect, otherwise it shall
be remain in full fbrce and virtue.
PROVIDED ALWAYS the liabitity of the surety hereunder shall not be impaired to
discharged by reason of time being granted or by any forbearance act or omission of
the Govt. or any person. authorized by them (whether with or without the consented
knowledge olthe sureties) not shall it be necessary fbr the Gor.t. to sue the obligor
belbre suing the sureties .
Dr.. . . .. ... ... . .. and
Dr or any ofthem lor amount due here under.
TFIE BON'D SHALL in all respecr be governed by ol laws of India for time being in
lorce and rights and liabilities hereunder shall where necessary be accordingly
determined by the appropriate courts in India.
THE GOVERNMENT OF KARNATAKA has agreed the stamp dury payable of this
bond.
Signed and dated this:
Signature of the obligor above named Dr. .............. .......In presence
of rvitnesses hereunder:-
WITNESSES: (Signature with Name and Full Address)
l
SWORN BEFORE ME
Sttplly (Signature rvith Nanre and Full Address)
Aadhar Voter ID KGID Passport
No No N{etal No Photo
Aadhar Voter ID KGID
No No Metal No Passport
Photo
er&d4tJ6
drordd esded doaJ6:
6uood dg esdeEad.:dod, ...............de uoesdee
dea-dedd Aoet.rod& uo.d&oe{d a-o6dorl{..........
aardridg oolneadrVoo6d:{ed. duordg dd" erdeddg * dddod dddlid"bd
&o,r,dJdd.
t. ua"ddoe$d uo6dorld dodd do{ to ddrrldJ e:doer} drQ *t^uoa:
de.ro6eo ee-roa3oJcer ded dgCogooh a-arlo de eodeong dono addg
eldao eod6 BeroeJ/drodrr/orid:risri (d6d6aeoi 6frlo eeraa3 deodod)
&oloead d:eeJ ddcatodod *oeOd dgd:d69.
z. ;n6dorld dodd aoo6drdri d{od drad dr€ Jresda3edodc obogde
alda egdao Uedd Jgiog6g.
c. udoerlS d;Q dcr^loa: dero6m eeroaSoj: ilod+ong oSj6e$d dd;u-oa$
dr€on6 uaoJcrodsaod:ded.
+. uo.d*oe$d a-o6dorl{ $ded ddd 6uood6od ag-a0rl ard)dod daaEdd
d.)oae.ooag egde eeqjdorrld: deddldd dedd ddo$o: e$dodag.
de d:eej .t6.sdrd ddQrldild ddJ tu&drooAdr{ed ood:* dmod
{draeSed0Cr:$ed. de d:eegd ddd:rlsri dader aoalnd; $rad Ae$a:{
a{o-ancb$ed.
dd
o tlesroadd d&
6uaod:
