SHRI BHAUSAHEB HIRE GOVT.

MEDICAL COLLEGE, DHULE

Maharashtra State

Welcome to the Undergraduate

students Joining our Institute for
the academic year 2023-24
Contact Person for query: (between 10:00 to 5:00 PM)
Landline number CET Cell : 02562- 298114 /239408
DON’T CALL ON THE PERSONAL NUMBER OF DEAN / NODAL OFFICER
 GOVT.OF MAHARASHTRA
SHRI BHAUSAHEB HIRE GOVT. MEDICAL COLLEGE, DHULE- 424311.
TELEPHONE NO. 02562 -298114/239408
e-mail:- [email protected]
www. sbhgmcdhule.org
FOR ALL INDIA/STATE QUOTA STUDENTS
NOTIFICATION (For NEET UG-2023 Admissions)
All the selected students of NEET-UG-2023 allotted seat at
Shri Bhausaheb Hire Govt. Medical College, Dhule (M.S.) should
follow instructions and accordingly report with all details required for
admission process.
1. Download & print this PDF file. READ ALL DETAILS CAREFULLY
2. Print TWO COPIES of 'Application for Admission' form, fill it
completely & submit at the time of admission.
3. All original documents enlisted in the Application form along with
TWO SETS of SELF ATTESTED photocopies of all original
documents are to be submitted in simple spring office file.
4. All Original Documents are to be scanned individually &
submit in a folder in pen drive. The folder should be named by
student's name. The scan should be in PDF format ONLY and
each file not beyond 500 KB. Pen drive submission will be
mandatory.
5. One Original & 2 photo copies of Medical Fitness in the
prescribed format are Required.
6. Fees will be accepted by the Demand Drafts (D.D.) only.
D.D. should be drawn from any Nationalized Bank in favour of …
“Dean, Shri Bhausaheb Hire Government Medical College, Dhule”
payable at Dhule.
Fees will not be accepted by Cash.
7. Kindly note…. Admission Process requires verification and
approval. No student will be given Joining letters urgently.
The office may require 2-3 days to complete the process.
8. For any query please call Landline number 02562- 297114 /239408
Do not call on personal Mobile number of Dean available on MCC
website, it is given for administrative use by MCC/DMER ONLY.
 Application for admission

Name:- __________________________________________

Address (In Capital) :- _____________________________

________________________________________________

Mobile No. Student :- __________________________

Recent
Passport size E-mail Address of Student :-______________________
Photograph
Mobile No. Parent :-___________________________

E-mail Address Parents :-______________________

Phone No. (Res.) :-___________________________

Date: :- / /2023

To,
The Dean,
Shri Bhausaheb HireGovt.
Medical College, Dhule.

Sub: - Joining in Ist MBBS Course at Shri Bhausaheb Hire Govt. Medical College, Dhule.

Ref:- Selection letter/List : (printout attached)

R/Sir,
I the undersigned Shri./Kum. (Full Name in Capital) ____________________
__________________ has been selected for Ist MBBS Course in Shri Bhausaheb Hire Govt.
Medical College, Dhule as per the Selection letter of All India / State list.
Kindly enroll me in your college as Ist MBBS student for the Academic Year 2023-2024.

Thanking you.

Yours faithfully,

(Name____________________________)
 Government of Maharashtra
Shri Bhausaheb Hire Govt.Medical College,Dhule
website:- http://sbhgmc.org e-mail:- [email protected], [email protected]
Phone No.: College :- (02562) 239407, 298114 Fax No. College:- (02562)
APPLICATION FORM FOR ADMISSION TO FIRST YEAR M.B.B.S. COURSE 2023-24
(Note: Use Capital Letters Only, Use √ Mark & Strike out whichever is not applicable, Do not overwrite.)
Paste recent
passport size
photograph
here.
1) CANDIDATE’S NAME (Strictly as per Class XII or Gazette Notification):

(Surname) (First Name) (Father’s/ Husband Name)

2) CANDIDATE’S NAME (in local language i.e Devnagari (Marathi) :

(Surname) (First Name) (Father’s/ Husband Name)

3) MOTHER’S FIRST NAME :

4) Gender : MALE FEMALE

5) Blood Group (with Rh) :

6) Type of admission(Quota)
:
7) Category : Open/ Reserved
If Reserved : SC/ ST/ NT(A)/ NT(B)/ NT(C)/ NT(D)/ OBC/ SBC/EWS/SEBC
Caste : _____________________CVC- Yes/No

8) NEET-2022 Roll No. : 9) NEET-2022Marks : Out of 720 Percentile

10) ALL INDIA RANK- 11) Application Number :

12) Allotment Date (CET CELL/ AIQ) :

13) Admission Date at College :
14) H.S.S.C. Passing Year :
15) H.S.S.C. Grand Total :
16) H.S.S.C. Board:
17) H.S.S.C. Attempts:
18) H.S.S.C. PCB Marks : Out of %
19) Would you like to apply for Hostel : Yes/ No
20) H.S.S.C. PCBE Marks : Out of %

21) Religion :

22) Last School/ College

attended:

23) Date of Birth :

Form Page 1
24) Place of Birth :

Married/ Unmarried
25) Marital Status :

26) Permanent Address :

PIN
Code

State: District: Tehsil:

Students’ Location
Rural/ Urban/ Tribal
Category:

Contact Details: Phone No.: Student Mobile No.:

Parent’s Mobile NO.:

Student E-mail ID : Parent’s Email id-

Willingness about organ donation after Accidental Death Yes / No

of student

Occupation of Father/ Mother/ Guardian:

Service/ Business/ Profession/Farmer/Laborer/ Retired

I hereby declare that, the information filled in by me in this form is true to the best of my knowledge.

I have Attached all the mandatory document as specified in the list documents as specified in the list-

Signature of the Student

Form Page 2
 List of Documents for Admission
Sr. Attached Sr. Name of Document/ Attached
Name of Document/ Certificate
No. (Yes/No) No Certificate (Yes/No)
1 Nationality Certificate 16 Aadhar Card
2 Domicile Certificate 17 Migration Certificate
(if applicable)
3 SSC Mark Sheet 18 Leaving/Transfer
Certificate
4 SSC Passing Certificate 19 Defense Certificate
5 HSC Mark Sheet 20 Physical Handicap
Certificate for PWD
(Annexure – “D”)
6 HSC Passing Certificate 21 Hilly Area Certificate
(Non Mandatory)
7 NEET Score Card-2023 22 Election Card
(Annexure-C if less than
18 Years)
8 Admit Card issued by NEET- 23 Passport ( if applicable)
UG-2023
9 Selection Letter CET CELL/ 24 Ration Card
AIQ-2023
10 Caste Certificate (if 25 Student’s Haemogram
applicable) Report (Two Copies)
11 Caste Validity Certificate 26 D.D. of Requisite Fees
12 Non- Creamy Layer 27 Passport size
Certificate (if applicable) Photographs- 04 Nos.
13 EWS Certificate 28 Income Certificate
2022-23 ( For EWS,
EBC Students)
14 Self-Educational Gap Affidavit
by student certified by
Executive Magistrate / Notary.
(If applicable)
15 Physical Fitness Certificate
[Do not leave any field blank strictly write “Yes” if document attached and “No” if not
attached. Write “N.A.” if not applicable. All certificates should be submitted in Original and
two sets of attested Xerox copies.]
Admission Status: Admitted/ Cancelled
DATE :____________ DEAN
Shri Bhausaheb Hire Govt.
Medical College, Dhule

Verification of Original Documents

(Note: Deficit of any original document found should be strictly mentioned below)
(1) (2) (3)
1. 1. 1.

2. 2. 2.
3. 3. 3.
4. 4. 4.
Remarks if any : Remarks if any : Remarks if any :

Name: Name: Name:

Designation: Designation: Designation:
Signature: Signature: Signature:

Form Page 3
 Shri Bhausaheb Hire Govt. Medical College, Dhule
Admission Year 2023-24 for M.B.B.S.

Fee Structure

Open Category (Maharashtra EWS/EBC

Reserved (For Maharashtra
State Quota) students only)
Category (Only for
& (General Administration
Maharashtra State Department Government
All India Quota Resolutionsno.RAD/4019/
Quota)
(Open & Reserved Category) C.R 31/16-A,
dated12 February, 2019
Sr.
Fee Amount Amount Amount
No.
01 Tuition Fee 1,25,700/- 00 62,850/-
02 Library Fee 1,000/- 1,000/- 1,000/-
03 Admission Fee 1,500/- 1,500/- 1,500/-
04 Gymkhana Fee 500/- 500/- 500/-
05 Development fee 5,000/- 5,000/- 5,000/-
06 Library Deposit 2,000/- 2,000/- 2,000/-
07 Caution Money 3,000/- 3,000/- 3,000/-
08 University Pro-rata 500/- 500/- 500/-
09 University 100/- 100/- 100/-
Development Fee
Total 1,39,300/- 13,600/- 76,450/-
Open Category Reserved Category EWS/EBC Category
1) D.D. Rs. 12,600/- 1) D.D.Rs. 12,600/- 1) D.D. Rs. 12,600/-
2) D.D. Rs. 1,26,700/- 2) D.D.Rs. 1,000/- 2) D.D. Rs. 63,850/-
 D.D. of any Nationalized Bank may be drawn in favour of “Dean, Shri
Bhausaheb Hire Government Medical College, Dhule” payable at “Dhule” At
any cost Cash will not be accepted.
 The demand draft will be deposit in the accounts only after confirmation of the
admission /status retention by the students
 If students are allotted another college in subsequent rounds of All india / state …..
In such situation, all the DDs will be refunded back to the student, all such students
will be required to pay an amount of Rs.1500/- as cash in the cash section of
accounts department.
 Amartya Shiksha Yojana - The student have to submit D.D. of Rs.797/- to the
college, one time installment for the insurance of the student after final
admission to the respective college. (National Insurance Company Limited”
Payable at Kolhapur.)
 FEE STRUCTURE MIGHT CHANGE DEPENDING ON INSTRUCTIONS FROM HIGHER AUTHORITIES.
 (Only All India Quota Reserve Category Student)
Annexure – III

Office of the ------------------------------------------------------------------------------------

-------------------------------------------------------------------------------------

Outward No. :- Date:-

TO WHOME IT MAY CONCERN

CERTIFICATE

This is to certify that, the Caste Certificate No.----------------------------------------------------------

Dated------------------------- issued to Mr./Miss------------------------------------------------------------

by the Tahsildar / Magistrate-------------------------------------------------------------------- is Valid.

Further, it is stated that there is no provision of issuing separate Caste Validity

Certificate in---------------------------------------------------------------------------------------------------
State.

Office Seal / Stamp Signature of Tahsildar / Magistrate / Issuing Authority

काय लय--------------------------------------------------------------------
------------------------------------------------------------------------------
जावक . िदनांक
जो कोई भी इससे संबंिधत है उसके िलए
माणप
मािणत िकया जाता है की, ी/कुमारी ----------------------------------------------------------
इनको,तहिसलदार/िज हा म ॅिज ेट ----------------------------------------------------------------------
काय लयदारा िनगिमत िकया हु या जात माणप मांक ----------------------------------------------िदनांक
वैध है |
तथा,--------------------------------------------रा यमे अलगसे जात वैधता माणप िनगिमत करने
कोई ावधान नही है |

काय लयीन मोहोर तहिसलदार/िज हा मॅिज ेट तथा

संबंधीत अिधकारी के ह ता र