Government of Karnataka

HAVERI INSTITUTE OF MEDICAL SCIENCES

HAVERI-581110
(Autonomous Institution of Government of Karnataka)

PROFORMA FOR ADMISSION TO UNDER GRADUATE (MBBS) COURSE

FOR THE
ACADEMIC YEAR 2022-23.
 GENERAL INSTRUCTIONS FOR THE STUDENTS WHO ARE TAKING ADMISSION
FOR 1st MBBS COURSE AT HAVERI INSTITUTE OF MEDICAL SCIENCES, HAVERI (HIMS).

1. Students must report in principal’s/Deans office at HIMS for MBBS admission on or before date indicated on
their selection letter issued by KEA/ NEET AIQ by10-00 am. If any student fails to report before the last date
indicated in the office letter, his/her admission will stand cancelled and the same will be intimated to concerned
authorities.
2. One of the parent / guardian must accompany students at the time of admission or Surrendering seats as certain
documents are to be signed by them.
3. The admission process is likely to take more than one day. Outstation candidates are requested to not cause
hurry in admission or surrendering seats.
4. The admission offered to a candidate will be only provisional. DME/RGUHS/MCC-DGHS are final authorities.
5. As the original documents will be sent to Rajiv Gandhi University of Health Sciences, Bangalore for admission
approval, students are instructed to keep atleast 3 Xerox copies of original documents with themselves for
future use.
6. Institute working hours: 10.00 am to 1.30 pm and 2.15 pm to 5.00 pm.
7. Each candidate must submit the following original certificates shown below along with three sets of attested
copies. The originals and Xerox must be produced in the prescribed sequence. CANDIDATES MUST
PROVIDE ONE FILE/FOLDER FOR THEIR ORIGINAL DOCUMENTS.
8. In case of AIQ/NEET seats- seat surrender procedure will be duly followed. Kindly generate online seat
surrender receipt and contact the NODAL officer of HIMS Haveri Dr.Kotresh Doddamane on phone 08375-
200015 / 9986361961. Kindly report on working days and take a note of Karnataka holiday schedules.
SUNDAY WILL BE HOLIDAY & on any other national holiday, the college office will remain closed.

Note:

1. Students admitting through KEA shall pay fees as prescribed by the KEA and reporting college
other fee amount to Institution - HIMS HAVERI
2. Students belonging to SC/ST category shall also pay tuition fees and register for reimbursement
under SSP Karnataka.
 REQUISITION LETTER
(FOR AIQ/KEA-NEET-2022 STUDENTS)

To
The Director, Date :
Haveri Institute of Medical Sciences
Haveri

Sir,
Sub:- Application for admission to I Year MBBS course at HIMS Haveri allotted
through AIQ/KEA-NEET-2022 – reg.

I, Sri / Kum.
S/o, D/o. have been allotted MBBS seat at HIMS Haveri by
AIQ/KEA through NEET-2022 Counseling. My details are as follows :
FOR AIQ/KEA-NEET-2022 STUDENTS
Admission Order No :
Date of issue :
NEET No :
Roll No :
Rank :
Claimed Category :
Allotted Category :
Fee paid at KEA :
Date of Reporting :

I am herewith enclosing the Challan for

Rs. (Rupees (Only)
Bearing No. Dated of
(Name of the Bank) towards admission fees along with necessary original documents.

Hence, I request you to admit me at HIMS Haveri for I MBBS course. Admission taken by
me is at my own risk & request. I am aware that my admission is subject to the approval of the
concerned competent authorities for which HIMS Haveri will not be held responsible for any
consequences / objections arise in future.

Further I hereby affirm that the information provided by me at HIMS Haveri during Ist
year MBBS admission is true and correct to the best of my knowledge. If at any stage, the
information / documents submitted by me is found to be false / invalid; my admission will be
liable to be cancelled / withdrawn.

Yours faithfully,

(Signature of the candidate)

(Signature of the parent /

ADDRESS FOR CORRESPONDENCE : Guardian of the student)
From :
 HAVERI INSTITUTE OF MEDICAL SCIENCES,HAVERI
Instructions for students seeking Admission to First MBBS
(Academic Year 2022-23)

Original documents along with Three Sets of Attested Photocopies and a Soft
Copy [in pdf format below 150 KB only] of all the documents individually scanned
and labelled along with Photograph(JPG format below 50 KB) on a pen drive to
be submitted in the following order.

1. NEET UG Score card.

2. NEET UG Admit card.
3. NEET UG Rank Card.
4. NEET /KEA Allotment Order.
5. SSLC Marks Card / Birth Certificate.
6. II PUC/12th Standard Marks card.
7. Study Certificate 1st Std to 12th Std
8. Transfer Certificate.
9. Domicile Certificate.
10. Caste Certificate. (For candidates claiming Reservation)
11. Income Certificate of Parent. (For candidates claiming Reservation)
12. Migration Certificate. (For CBSE/ICSE/AIQ Students)
13. Eligibility Certificate issued by RGUHS. (For CBSE/ICSE/AIQ Students other than
PU Board Karnataka only)
14. Physical Fitness Certificate. (Issued by authorized Government Medical Officer)
15. Rural Service Bond. (Rs.100/- Bond paper-Duly Notarised) (Format provided to be
downloaded)
16. Anti Ragging Bond. (Rs.50/-& 50/- bond paper -Duly Notarised) (Format provided to be
downloaded)
17. RGUHS Bond. (Rs.50/- bond paper -Duly Notarised) (Format provided to be downloaded)
18. Photograph. (3 Pass Port Size and Soft copy in JPG less than 50KB)
19. Aadhar card. (Photo copy)
20. Physical Disability Certificate. (For differently disabled candidates as per norms)
21. Xerox Copy of Fee Receipt.
22. Online Fees payment Details are in last page of the Proforma.
23. General Affidavit Bond (Rs.20/- bond paper -Duly Notarized) (Format provided to be
downloaded)

THE FOLLOWING DOCUMENTS TO BE FILLED UP IN CAPITAL LETTERS

ONLY (FORMAT PROVIDED TO BE DOWNLOADED)
 OFFICE NOTE.
 PARTICULARS OF UNDER GRADUATE STUDENT.
 DECLARATION.
 FORMAT FOR OBTAINING TRANSFER CERTIFICATE.
***********
 Date:
OFFICE NOTE
Sub: - Admission to MBBS Phase-I for the Academic Year 2022-23 – reg.
*****
TO BE FILLED BY CANDIDATE IN CAPITAL LETTERS ONLY
DEGREE MBBS 2022-23 AIQ SEQ Counseling session( Round) I II III MOP UP
Mr./Miss
Mother’s Name
Father’s Name
UG NEET Roll No.
All India Rank No.
State Rank No.
UG NEET Score /720
UG NEET Percentage %
UG NEET Percentile
has submitted the following Original certificates.
Sl No Particulars Submitted Not Submitted

1 NEET UG Admit card

2 NEET UG Score card
3 NEET UG Rank Card
4 NEET /KEA Allotment Order
5 SSLC Marks Card / Birth Certificate
6 II PUC/12th Standard Marks card
7 Study Certificate
8 Transfer Certificate
9 Domicile Certificate
10 Caste Certificate (For candidates claiming Reservation)
11 Income Certificate of Parent (For candidates claiming Reservation)
12 Migration Certificate (For CBSE/ICSE/AIQ Students)
13 Eligibility Certificate issued by RGUHS (For CBSE/ICSE/AIQ Students)
14 Physical Fitness Certificate ( Issued by authorized Government Medical Officer)
15 Rural Service Bond (Rs.100/- Bond paper-Duly Notarised)
16 Anti Ragging Bond (Rs.50/- bond paper -Duly Notarised)
17 Photograph (3 Pass Port Size and Soft copy in JPG less than 45KB)
18 Aadhar Card (Photo copy) No:
19 Physical Disability Certificate No:
(for differently abled candidates) Issued by:
20 Bank Syndicate Bank Branch KIMS Campus, HUBBALLI
Fee Details
Receipt No. Amount Rs. Date

Signature of Candidate Signature of Parent/Guardian

Remarks: OFFICE USE ONLY

Provisional admission
approval.

Scrutiny Officer Section Incharge/CaseWorker Office Superintendent Assistant Administration Principal

Officer
 PARTICULARS OF UNDER GRADUATE STUDENT (MBBS) ACADEMIC YEAR 2022-23

Counseling session
MBBS 2022-23 AIQ SEQ I II III MOP UP
(Round)
Sl.
No. Particulars TO BE FILLED IN CAPITAL LETTERS ONLY
1 Name of the Candidate
2 Gender
3 Native Place
4 Date of Birth with Age
5 Mother’s Name
6 Father’s Name
7 Father’s Occupation
8 Mother’s Occupation
9 Parents Income per Annum
10 Religion
11 Caste
12 Sub-caste
Permanent Address
13

Correspondence Address
14

15 Landline Phone No( With STD Code )

16 Mobile No
17 Email ID
18 Aadhar No
19 Blood Group & Rh typing
20 Institution last studied
21 Highest examination passed II PUC/12th Standard

22 Registration No.( II PUC/12th Standard)

Total Marks Scored ( II PUC/12th Standard) / %
23
English /100 %
Physics /100 %
Chemistry /100 %
24
Biology /100 %
Total in PCB /300 %
25 UG NEET Roll No.
26 UG NEET Score /720
27 UG NEET Percentage %
28 UG NEET Percentile
29 All India UG NEET Rank
30 KEA/State UG NEET Rank
31 AIQ/KEA Admission Order No.& Date

32 Reservation Quota Claimed

33 Reservation Quota Allotted
34 Hyderabad Karnataka Quota Yes / No
35 Physical Handicap Quota Yes / No
36 Date of joining the UG course

Place: HAVERI
Date:
Signature of Candidate Signature of Parent/Guardian
 HAVERI INSTITUTE OF MEDICAL SCINCES HAVERI
(Autonomous Institution, Government of Karnataka)
# 1, District Hospital Campus, Kaginele Road, Haveri - 581110,
Telephone : 08375-200015 website: https://himshaveri.karnataka.gov.in E-Mail [email protected]

No:HIMS/Admissions/UG/2022-23Date:10-10-2022

UNDER GRADUATES IstYr MBBS FEES STRUCTURE 2022-23

SI.No Particulars 1st Year 1st Year General & Other Category-1st
Admission AIQ Admission Year
SC/ST (State Paid to KEA
Quota + To be paid
at college
1. Tuition Fee 50000

2. Helinet 4500

3. Registration 3000

4. Admission 500

5. SWF University(4½yrs) 450

6. Sports (4½yrs) 900

7. ID card 250

8. Student Association. 500

9. Sports fee 1200 Students shall

Includes tuition Includes pay reporting
10. Library fess Rs 50000/-, 1500 tuition fees Rs amount of Rs
RGUHS fees Rs 50000/-, 14750/- at
11. Magazine fee 1500 RGUHS fees college after
9350/-
12. Laboratory fee And college other 2500 Rs 9350/- paying tuition
fee Rs 14750/- And college and RGUHS
13. Medical Examination fee 300 other fee Rs fees to KEA
14750/-
14. Caution Deposit 1000

15. Alumni association fee (life 1000

time)
16. Kannada Sangh 1000

17. Cultural activities 1700

18. Literary activities 500

19. SWF (college) 300

20. 20 NSS activates 100

21. Skill lab fee 1000

22. Others 400

TOTAL 74,100 74100 74,100

HOSTEL FEE TO BE PAID SEPERATELY

 TO BE FILLED IN CAPITAL LETTERS ONLY

DECLARATION

To
The Director,
Haveri Institute of Medical Sciences,
Haveri-581110

Sir/Madam,

I S/o./D/o.
UG NEET Roll No AIQ Rank No._ KEA Rank No.
AIQ/KEA admission order No. Dated
Category Claimed Category Allotted have joined the I MBBS
Course at Haveri Institute of Medical Sciences, Haveri at my own risk.

I agree that I will submit the

1. Migration Certificate
2. Transfer Certificate from the previous College which I have studied within one month from
the date of my admission.

Further I have claimed the seat under reservation category and I

will be submitting the Validity Certificate and Caste Certificate within one week from the date of my
admission.

Place: Haveri
Date:

Signature of Candidate Signature of Parent/Guardian

 FORMAT FOR OBTAINING TRANSFER CERTIFICATE
SL.NO. PARTICULARS TO BE FILLED IN CAPITAL LETTERS ONLY
1 Name of the Candidate

2 Gender

3 Date of Birth with Age

4 Father’s Name

5 Nationality

6 Religion

7 Caste

8 Sub-caste

9 Category

10 Institution last studied

th
Highest examination passed II PUC/12 Standard
11
th
12 Registration No.( II PUC/12 Standard)
13 Month & Year Of Passing
Date of joining to
Haveri Institute of Medical Sciences,
14 Haveri -580001 Karnataka

Place: Haveri
Date:

Signature of Candidate Signature of Parent/Guardian

OFFICE NOTE
(For office use only)

The above candidate has been admitted to Ist MBBS Course at Haveri Institute of Medical
Sciences, Haveri on .The Transfer certificate of the candidate to
be sent to the Principal, HIMS, Haveri, Karnataka

Director
Haveri Institute of Medical Sciences
Haveri -581110 Karnataka
To,
 ANNEXURE - 9

EXECUTION OF BOND BY CANDIDATE WHO SELECTS MBBS SEAT IN MEDICAL COLLEGES OF

KARNATAKA(To be deposited after allotment of seats along with other originals)

(On Rs.100/- e-Stamp Paper)

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

a candidate with UGNEET 2022 Admission Ticket No……………………

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 6-07-2017 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

Date:………………….. (Father / Mother)

Place…………………..

Witness:

1.

2.

Rs. 100/- - E-Stamp Papers to be purchased in the name of :-

First party :- Student’s Name

Second party- Director of Medical Education Bengaluru.
 ANNEXURE - 1
GENERAL AFFIDAVIT
( To be submitted on Rs 20/- Bond paper (To be deposited after allotment of seats along with other originals))

I, …………………………………………………...…………….. son /daughter of ………………………

residing at ................................................................................................. have appeared for UG NEET 2022
conducted by CBSE, New Delhi with Roll Number _ and Register Number ......................... and
have secured .......... Score in the said test.
I hereby solemnly declare that during 2022, I have not taken MBBS / BDS admission in any college
Allotted by other exam conducting bodies. I have not surrendered any seat in past UG exams/other
UG entrance exams conducted by central / state Government and various other authorities.
I shall immediately notify the Karnataka Examinations Authority, Bangalore if I am getting admission
in any college through other exam conducting bodies.
I shall also not surrender any seat after the admission at institute level through any seat allotting
bodies, if I need to surrender I shall do so at Karnataka Examinations Authority, Bangalore.
I shall produce all required original documents for verification and submit the same after allotment
of seat to concerned college.
I shall not produce/submit fake/concocted documents for verification or admission.
I will forfeit the seat allotted to me and also I am liable for criminal proceedings if any one of the
above information/documents produced by me is found to be false / incorrect.

Date:
PLACE: Deponent

Signature of the Candidate Sworn Before Me

Rs. 20/- - E-Stamp Papers to be purchased in the name of :-

First party :- Student’s Name

Second party- Director of Medical Education Bengaluru.
 TO BE TYPED IN RS.50/- E-STAMP PAPER

ANNEXURE I
FORMAT OF UNDERTAKING BY THE STUDENT

1. I,
(Full Name in Block Letters)

Admitted to the course of with admission No.

(Name of Course)

at
(Name of College / Institution)

Affiliated to
(Name of University)

have received a copy of the REGULATIONS FOR PREVENTION AND PROHIBITION OF

RAGGING IN MEDICAL COLLEGES / INSTITUTIONS, 2022 of the National Medical Commission
(NMC).

2. I have carefully read and fully understood the provisions in these regulations.
3. I have particularly perused CHAPTER-II SECTION-3 and have fully understood what
constitutes “Ragging”.
4. I have also in particular perused Chapter IV and read and understood the Administrative and
Penal actions that may be taken against me in case I am found guilty of ragging or abetting
ragging actively or passively, or being part of a conspiracy to promote ragging.
5. I hereby under take that –

(i) I will not indulge in any behavior or act that may come under the definition of ragging
as may be constituted under Section 3 of these regulations.
(ii) I will not participate in or abet or propagate ragging in any form included but not limited
to those that may be constituted under Section 3 of these regulations.
(iii) I will not hurt anyone physically or psychologically or cause any other harm.

6. I hereby agree that if I found guilty of any aspect of ragging, I may be punished as per the
provisions of the NMC Regulations mentioned above and/or as per the law in force.

7. I also declare that I have never been found to be guilty of raging or abetting ragging, actively or
passively, or being part of a conspiracy to promote ragging and have never been punished in
any manner for these offences and further affirm that if this declaration is incorrect or false, my
admission is liable to be cancelled / withdrawn.

Signed this day of month of year

Student’s Signature Signature of Witness 1 Signature of Witness 2

Name : Name : Name :

Address : Address : Address :

Tel/Mobile No: Tel/Mobile No. Tel/Mobile No :

Rs. 100/- - E-Stamp Papers to be purchased in the name of :-

First party :- Student’s Name
Second party :- Director HIMS Haveri.
 ANNEXURE II

FORMAT OF UNDERTAKING BY PARENT / GUARDIAN OF THE CANDIDATE / STUDENT

1. I,
(Full Name in Block Letters)
Father / Mother / Guardian of Mr./Mrs.Ms. _

Admitted to the course of with admission No.

(Name of Course)
at
(Name of College / Institution)

Affiliated to
(Name of University)
hereby declare that I have received a copy of the REGULATIONS FOR PREVENTION AND
PROHIBITION OF RAGGING IN MEDICAL COLLEGES / INSTITUTIONS, 2022 of the National
Medical Commission (NMC).
2. I have carefully read and fully understood the provisions in these regulations.
3. I have particularly perused CHAPTER-II SECTION-3 and have fully understood what
constitutes “Ragging”.
4. I have also in particular prsued Chapter IV and read and understood the Administrative and
Penal actions that may be taken against my son / daughter / ward in case he / she is found
guilty of ragging or abetting ragging actively or passively, or being part of a conspiracy to
promote ragging.
5. I hereby undertake that my son / daughter / ward –

(iv) Will not indulge in any behavior or act that may come under the definition of ragging as
may be constituted under Section 3 of these regulations.
(v) Will not participate in or abet or propagate ragging in any form included but not limited
to those that may be constituted under Section 3 of these regulations.
(vi) Will not hurt anyone physically or psychologically or cause any other harm.
6. I hereby agree that if my son / daughter / ward is found guilty of any aspect of ragging, he /
she may be punished as per the provisions of the NMC Regulations mentioned above and/or as
per the law in force.
7. I also declare that I have never been found to be guilty of raging or abetting ragging, actively or
passively, or being part of a conspiracy to promote ragging and have never been punished in
any manner for these offences and further affirm that if this declarations is incorrect or false,
my admission is liable to be cancelled / withdrawn.

Signed this day of month of year

Parent/Guardian of the Signature of Witness 1 Signature of Witness 2

Candidate / Student’s
Signature

Name : Name : Name :

Address : Address : Address :

Tel/Mobile No: Tel/Mobile No. Tel/Mobile No :

Rs. 100/- - E-Stamp Papers to be purchased in the name of :-

First party :- Father / Mother / Guardian’s Name
Second party :- Director, HIMS, Haveri.
TO BE FILLED IN CAPITAL LETTERS ONLY
 NOTARISED BOND TO BE EXECUTED ON A STAMP PAPER OF RS.50/-

I S/o./D/o.
(hereinafter called the Natural Guardian of the Student) UG NEET Roll No AIQ
Rank No. KEA Rank No. AIQ/KEA admission order No.
, dated Category Claimed CategoryAllotted
Resident of

hereby give an undertaking that on admission to I MBBS at Haveri

Institute of Medical Sciences, Haveri during the Academic year 2022-23, have understood the Rule No.11 of
the Ordinance Governing M.B.B.S Degree Course of Rajiv Gandhi University of Health Sciences, Karnataka,
Bengaluru vide Notification No. ACA/BOS-27/97-98 Dated: 24-03-1998 and I shall abide by the ordinance.

That no student shall be permitted to join Phase-II (Para Clinical & Clinical) Group of subjects until
he/she passes in the Phase-I (Pre-Clinical) Subject for which he/she will be permitted not more than four
chances (Actual Examination) provided four chances are completed within three years from the date
enrolment.

I shall abide by the Rules of Conduct and Discipline of the institution and abstain from practicing
ragging in any form.

Place: Haveri
Date:

Signature of Candidate Signature of Parent/Guardian

Witness (Signature with Address)

1)

2)

Rs. 50/- - E-Stamp Papers to be purchased in the name of :-

First party :- Student Name

Second party- Director, HIMS Haveri.
No: HIMS:UGS: :2022-23 Office of the Director,
Haveri Institute of Medical Sciences,
Haveri. Date : - -2022

OFFICIAL MEMORANDUM
Sub : MBBS Phase-I admission through NEET AIQ-2022 reg.
Ref : All India Quota NEET-2022 Medical Counseling, New Delhi
Online generated provisional seat allotment letter Dt. - -2022
*****
Mr./Miss Category
Seat Allotted Category Merit/Rank No. Roll No.
who has been allotted MBBS seat during First/Second round NEET 2022 counseling under AIQ
(15%) counseling to Haveri Institute of Medical Sciences, Haveri has been reported and provisionally
admitted to MBBS Phase-I on , subject to the approval of concerned authorities. He/She has
submitted all relevant originals certificates and testimonials to this college.

Director,
Haveri Institute of Medical Sciences,
Haveri-581110.
To, The Above Candidate.

No: HIMS:UGS: :2022-23 Office of the Director,

Haveri Institute of Medical Sciences,
Haveri . Date : - -2022

OFFICIAL MEMORANDUM
Sub : MBBS Phase-I admission through NEET AIQ-2022 reg.
Ref : All India Quota NEET-2022 Medical Counseling, New Delhi
Online generated provisional seat allotment letter Dt. - -2022
*****
Mr./Miss Category
Seat Allotted Category Merit/Rank No. Roll No.
who has been allotted MBBS seat during First/Second round NEET 2022 counseling under AIQ
(15%) counseling to Haveri Institute of Medical Sciences,Haveri has been reported and provisionally
admitted to MBBS Phase-I on , subject to the approval of concerned authorities. He/She has
submitted all relevant originals certificates and testimonials to this college.

Director,
Haveri Institute of Medical Sciences,
Haveri-581110
To, The Above Candidate.
 UG Section Date: - -2022
HIMS, Haveri.

[1] SUBMITTED.

Mr./Miss Merit No.

Roll No. has been selected for the MBBS course under NEET AIQ (15% )

Under graduate Medical Counselling-2022 [NEET AIQ Quota] through First/Second round

counseling for the academic year 2022-23 has requested this office to admit him / her for the MBBS Course.

He/She has submitted online generated selection order- through AIQ Quota Under graduate

Medical Counselling-2022 [ NEET AIQ Quota] New Delhi and Original and Xerox copies of all

marks card and other documents etc.

He/She has given a letter/undertaking that his / her admission to this college is provisional and at

his / her own risk. (Subject to issue of final eligibility from RGUHS Bangalore).

Hence, Provisionally approve his / her admission.

Therefore for kind orders and guidance.

1. Scrutiny Officer :

2. C/W :

3. Office Superintendent :

4. AAO :

5. Nodal Officer :

6. Director :
No: HIMS:UGS: :2022-23 Office of the Director,
Haveri Institute of Medical Sciences,
Haveri . Date : - -2022

OFFICIAL MEMORANDUM
Sub : MBBS Phase-I admission through State Quota-2022 reg.
Ref : Online generated provisional seat allotment letter Dt. - -2022
*****
Mr./Miss Category
Seat Allotted Category Merit/Rank No. CET No.
who has been allotted MBBS seat during First/Second round NEET 2022 counseling under State
Quota (85% ) to Haveri Institute of Medical Sciences, Haveri has been reported and provisionally
admitted to MBBS Phase-I on , subject to the approval of concerned authorities.
He/She has submitted all relevant originals certificates and testimonials to this college.

Director,
Haveri Institute of Medical Sciences
Haveri
To, The Above Candidate.

No: HIMS:UGS: :2022-23 Office of the Director,

Haveri Institute of Medical Sciences,
Haveri. Date : - -2022

OFFICIAL MEMORANDUM
Sub : MBBS Phase-I admission through State Quota-2022 reg.
Ref : Online generated provisional seat allotment letter Dt. - -2022
*****
Mr./Miss Category
Seat Allotted Category Merit/Rank No. CET No.
who has been allotted MBBS seat during First/Second round NEET 2022 counseling under State
Quota (85% ) to Haveri Institute of Medical Sciences, Haveri has been reported and provisionally
admitted to MBBS Phase-I on , subject to the approval of concerned authorities.
He/She has submitted all relevant originals certificates and testimonials to this college.

Director,
Haveri Institute of Medical Sciences
Haveri
To, The Above Candidate.
.
UG Section Date: - -2022
HIMS,Haveri.

[1] SUBMITTED

Mr./Miss Merit/Rank No.

CET No. Category Seat Allotted Category Allotment

Dated has been selected for the MBBS course under NEET State Quota 85% Under

graduate Medical Counselling-2022 through First/Second round counseling for the academic year 2022-

23 has requested this office to admit him / her for the MBBS Course.

He/She has submitted online generated selection order- through State Quota Under graduate

Medical Counselling-2020 and Original and Xerox copies of all marks card and other documents

etc.

His/Her admission to this college is provisional and at his / her own risk. (Subject to issue of final

eligibility from RGUHS Bangalore).

Hence, Provisionally approve his / her admission.

Therefore for kind orders and guidance.

1)Scrutiny Officer :

2) C/W :

3) Office Superintendent :

4) AAO :

5) Nodal officer :

6) Director :
 Please Download The Proforma from www. https://himshaveri.karnataka.gov.in
And Submit the filled information Along with Original
Documents & THREE SETS Of Self Attested
Xerox Copies To HIMS Office During
Admission To First Year MBBS
Course.

MBBS ADMISSION FEES DETAILS 2022-23

Required: Original fees challan ‘office copy’ submit to the Account Section, HIMS Haveri and their
2 sets xerox copies submit at UG Section.