KA.MINE.

NJ ACADEMY OF MEDI CAL SCIENCESAND RESEARCH CENTRE

L.B.NAGAR, HYDERABA.D-500068.

ADMISSION FOR - l st YEAR MBBS 2023- 24

LIST OF CERTIFICATES REQUIRED

I. Allolment Letter from K.NRVHS, Warangal.

2. KN RU.HSOolinc Provisional Verification Report.
3. Original Admit Card(NEET). &Original Rank C ard(NEET).
4. S.S.L.C./S.S.C/Senior Cambridge/Certificate showing 1bc Dale of Birth.
s. Memorandum of Marks. lnter/B.Sc./ Al.H.SC/PUC/M.Sc.
6. Equivalence Certificatc(lntermediate) in case of state other than Tclangana/ Andbra Pradesh.
7. Transfer certificate (TC).
s. Original Bonafide Certificates as follows:
a. VI to X C lasses b. inter l & l1l Year
9. Recent Social Status certificate (if required) in original from M.R.O.
10. Service r ecords of the parents or SSC/SSLC Certificate of Parent / Relative if parent is not i11 service.
11. Xerox Copy Photo Identity Proof(Aadhar Card/Pancard)(Student's).
12. Minority Certificate issued by appropriate authority (lf applica ble)
13. Candidates who have studied in 1hc institutions outside T ela ngana have to submit IO yearsRcsidence
CertificateOflhe Student/Parent issued by MRO/Tah sildhar excluding period of Study/ Employment.
14. Latest !Jllcomc Certificate of Father / GuaJrdian with Ration Card in case of claiming fee exemption [Original]

for Cat-A Students only.

15. La1estSix Passport size photographs &Fou.r Stamp Size Photographs.
16. Gap certificate if not studied after passing qualifying exams from Principal of the college or M.R.O
17. AntiraggingAffidavit by the studcnt&Pa rcn t on Rs. I 0Q/. bond paper scparately(Duly Notarized) as per (ANNEXURE-1& 11).
18. Disconti nuation BondMBBS (on non-judicial stamp paper of Rs.100/)(Duly Notarized) as per for KNRUHS
(ANNEX URE -111)
19. Oiscontiinuation Bond MBBS (on non-judicial stamp paper of Rs.JOO/) (Duly Notarized) as per for KAMSRC
(ANNEXURE- 1.11 A)
20. Under taking in the form of Affidavit(on non-judicial stamp paper ofRs.100/)(Duly Notarized) as per (ANNEXURE-l V)

21. Declarntion by Candidate /Parent (on non-judicial stamp paper ofRs.10/).(Notary)forB & C Category{ANX- V)

22. Bank G uarantcc(BG) (From any Nationalized Bank) forB & C Category only.(ANNEXURE - VI)

23. For NRI (C -catcgory)documents required

a . NRl Sponsorsb.ip certificate[ D eclaration Form] as per {Al"NEXURE-VII)

b. NRJ s tatus certificate of financial s upporter issued by the Embassyof their respective Country under their seal.
c. Copy of NRI Bank account pass hook&Pass portof the financial supporter of L year.
24. Two (2) Sets of Xerox Copies of all the above Certificates in the above order ( I set self attested)
25. Fee Payment details ( copy of the fee receipt )
(So ft copies ofaU the annexurcs are available on college website under UG Admissions. Website: www.kams rc.com)
 ANNEXURE -I
AFFIDAVIT BY THE STU DENT
I, . Admn. No. _ _ _ _ _ _ _ _ _ __
Slo. I Dlo _ _ _ _ _ _ ___, having been admitted to KAMJNENI ACADEMY Of
MEDICAL SCfENCES AND RESEARCH CENTRE. L.B.NAGAR, HYDERABAD -500068
have received a copy of the UGC Regulations on Curbing the Menace of Ragging in Higher
Educational Institutions, 2009, (bereinafier called the "Regulations") carefully read and fu lly
understood the provisions contained in the said Regulations.

1. I have, in particular. perused clause 3 of the Regulations and am aware as to what

constitutes ragging.
2. I have also, in particular, perused clause 7 and clause 9.1 of the Regulations and am fully
aware of the penal and administrative action that is liable to be taken against me in case l am
found guilty of or abetting ragging, actively or passively, or being part of a conspiracy to
promote ragging.
3. I hereby solemnly aver and undertake that
a) I will not indulge in any behavior or act that may be constituted as ragging under clause
3 of the Regulations.
b) I will not participate in or abet or propagate through any act of commission or omission
that may be constituted as ragging under clause 3 of the Regulations.
4 . I hereby affirm that, if found guilty of ragging, I am liable for punishment accord ing to
clause 9.1 of the Regu lations. without prejudice to any other criminal action that may be
taken against me under any pena l law or any law for the time being in force.
5. I hereby declare that I have not been expelled or debarred from admission in any institut ion
in the country on account of being found guilty of, abetting or being part of a conspiracy to
promote, ragging; and further affirm that, in case the declaration is found to be untrue, I am
aware that my admission is liable lo be cancelled.
6. I hereby declare that I submit online Undertaking to the websi te www.antiragging.in and
www.amanmovemcnt.org.

Declared on this date (DD/MMNYYY) : _ _ __

Signature of deponent
Name:
Address:

VERI FICAT ION

Veri fied that the contents of this affidavit are true to the best of my knowledge and no part of the
affidavit is false and nothing has been concealed or misstated therein.

Verified at Hyderabad on thjs date: _ _ _ __

Signature of deponent

Solemnly affirmed and signed m my presence on this date: _ _ _ _ _ after reading the
contents of this affidavit.

OATH COMM ISS IONER

(6)
 ANNEX URE - 11
AFFIDAVIT BY TH E PARENT

I, - - -~ - - - - - - - - ' F/o / Mio.

Admn. No. _ _ _ _ _ _ - - - - - - - - - - ~ ~.- h_a_v-in_g_ b_e_e_n_ a_d_n-1i-tt-e d- - to
KAMINE N I ACADEM Y OF MEDICA L SClENC ES AND RESEAR CH CENTRE ,
L.B.NAG AR, HYDERA BAD -S00068 have received a copy of the UGC Regulatio ns on
Curbing the Menace of Ragging in Higher Educational Institutions, 2009, (hereinaf ter
called the .. Regulatio ns") carefull y read and fully understoo d the provisions contained in
the said Regulatio ns.
I. I have, in particular, perused clause 3 of the Regulat;o ns and am aware as to what
constitute s ragging.
2. I have also, in particular . perused clause 7 and clause 9. 1 of the Regulations and am
fully aware of the penal and administr ative action that is liable to be taken against
my ward in case he is found guilty of or abetting ragging, actively or passively, or
being part of a conspirac y to promote ragging.
3. I hereby solemnly aver and undertake that
a) My ward will not indulge in any behavior or act that may be constituted as
ragging under clause 3 of the Regulatio ns.
b) My ward will not participat e in or abet or propagate through any act of
commiss ion or omission that may be constitute d as ragging under clause 3 of
the Regulations.
4 . I hereby affirm that, if found guilty of ragging, I am liable for punishme nt according
to clause 9.1 of the Regulat ions, without prejudice to any other cri minal action that
may be taken against me under any penal law or any law for the time being in force.
5. I hereby declare that my ward has not been expelled or debarred from admission in
any institutto n in the country on account of being found guilty of, abetting or being
part of a cons piracy to promote, ragging; and further affim1 that, in case the
declaratio n is found to be untrue. I am aware that my ward's admission will be
liable to be cancelled .
6 . I hereby declare that I s ubmit online Undertak ing to the website www.antiragging.in
and www.am anmO\em ent.org.

Declared on this date(DD/ MM/YY YY): _ _ _ __

Signature of deponent
Name of the parent:
Address:
Mobile No:

VERIFI CAT ION

Verified that the contents of this affidavit are true to the best of my knowledge and no
part of the affidavit is false and nothing has been concealed or misstated therein.
Verified at Hyderaba d on this Date: _ _ _ __

Signature of deponent
Solemnly affirmed and signed in my presence on this date: _ _ _ _ _ after reading the
contents of this affidavit.

OATH COM MI SSI ONER

(7)
 ANNE X URE - W A

(NON -J UDIC IAL STAM PED PAPE R FOR RS.10 0/-)

SURE TY - BOND

I Mr/M s ........ . .. ..... .. ... . ........ .. ........ ...... S/o, DI o . . . . . . . .

. . . . . . . . . .. . . . . . . . . . . . . . . I" year
MBBS studen t, joined at Kamin eni Acade my of Medic al Scienc
es and Research Centre in
the year 2023- 24 under Convener Quota / Manag ement Quo ta
( B & C Categories ) , do
hereb y undert ake to complete the said course as per the requirement
s of the KNR UniYersity of
Health Scienc es, Warangal and as per the norms o f the i-nanagcment
o f Kamineni Academy o f
Medic al Scienc es And Resea rch Centre , L.B.N agar, that in the
event of my leaving the
stucllies in the mid-te rm aner closin g of admissions , l undert
ake to pay to Kamineni
Acade my of Medical Scienc es And Research Centre. L.B.N agar
Lhe balance of fees for the
rem aining penod of the course .

Date:
Signa ture of the Candi date
Witnesses: Mobile .No:

1. S ignature
Signa ture of the Paren t
Name & Address
Mobil e No
Addre ss:
2. Signat ure
Mobil e .No:
Name & Addre ss
Mobil e
 A.~NEXU RE- Ill

KALOJI NARAYANA RAO UNIVERSITY OF HEALTH SCIE

NCES,
TELANGANA:: WARANGAL
MBBS/BDS ADMISSIONS 2023 -24
PROFORMA FOR BOND MBBS/BDS CO N NO N-JUDICIA
L STAMP PAPER FOR Rs.JOO/-)

I. Mr/Ms . _......,___ ___ ___ ___ ___ ___ ___ _S/

o:0/o:_ _ _ _ __ _ __ __
selected for MBBS/BDS Course for 2023 -24 do hereb
y under take to comp lete the course as per
the regulations of Kaloji Nara yana Rao University of
Health Sciences and in the event of my
disco ntinu ing the studies after joinin g the course after
the last date for free exit for admissions o f
CQJM Q as notified by University . I under take to pay
the university a sum of Rs.20. 00.00 0/-
(Rupees Twen ty Lakhs o nly)

Signature of the Cand idate

I.Mr/ Mrs.
Mr/ Ms . _ _ _ _ _ __ _ _ _ _ _ _ hereb y paren t of
unde rtake to pay Kaloji Naray ana
University of Healt h Sciences. a sum of Rs. 20.00 .000
( Rupees Twen ty Lakhs only) in case of
disco ntinu ation of MBBS/BDS Cour se after joining by
Son/D aught er after the last date for free
exit for admissions of CQJM Q as notified by University.

This bond shall in all respects be gove rned by the Laws

of India . for the time being in
force. and the rights and liabilities shall. wher e neces
sary. be accordingly deter mine d by the
appropriate courts in India.

This bond is exem pted from stamp duty. unde r Artid

e 57 of Schedule- I of the Indian
Stam p Act. 1899. (Central Act II of 1899)

WHEREAS for the bette r prote ction o f the Gove

rnme nt. the Party of the FIRST
PART has agree d to execu te ithe bond with 2 Wlteness who are Gove rnme
Offic ers/ Inco me Tax assesses to stand guara ntee for the nt Gaze tted
abov e said amou nt.

Date (DD/MM/YYYY): Signature of Parent

Witeness
1. Signa ture:

Nam e and Address in full.

2. Signa ture:

Nam e and Addr ess in full.

 (ANN EXURE-IV)
PRO FORM A FOR UNDERTAIKNG IN THE FORM OF AFFIDAVIT(ON NON -
JUDICIALSTAMP PAPERS OF RS.100/-)

UNDERTAKING

I•••••••••••••••••••••• •• ••••••• ••• •••••••• • ••••••••••••••••••• •• ••••••••••.•••••..•.. • .•.•....•••••.• S/o I

D/0................. .......... .. ....... .. ..... ........................ ......... bearing UG NEET 2023 Rank

No ...... ......................... .

and

1............................................................................................................ Wo/
F/0............................................ ..................... ...... ..... bearing UG NEET 2023 Rank No

hereby give an undertaking as below. in connection with o ur claim with regard to certificates submitted

for admission Into UG Medical course for the Academic year 2023-24 in colleges affiliated to KNR.

University of Health Sciences .We .hereby declare that all o ur certificate.s are genuine.

I am aware that if the submitted relevant certificate (s) is /are found to be not genuine at a later date. my

admission is liable to be cancelled and I am liable for criminal prosecution. as may be legally deemed

fit.Further I agree that I abide by the Ru les and Regu lations of KNR University of Health Sciences.

I also hereby undertake that I shall not enter into legal litigation, if the seat allotted to me is

cancelled. for the above reasons.

Signature of the parent / Guardian Slg;nature of the Candidate

Adhar No : AdharNo :

Address: Address :

Date (DD/MtvVYYYY):Place:
 l@j
(ANNEXURE-V)

KALOJI NARAYANA RAO UNIVERSITY OF HEALTH SCIENCES,

TELANGANA:: WARANGAL
MBBS/ BDS ADMISSIONS 2023-24 UNDER MANAGEMENT QUOTA

DECLARATION BY CANDIDATE / PARENT ON NON-JUDICIAL STAMP PAPER FOR Rs.10/-)

I. Mr/ Ms._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _S/ o: 0/o:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Selected for MBBS/ BDS Course for the year
2023-24 under Management Quota declare that I am not admitted in any other Medical College
in the country as on today. I am not a part of any seat blocking procedure. I will not discontinue
the course without valid seat allotment at a later date in other college. In case of any discrepancy
I am liable for legal action by KNR University of Health Sciences and Government and
cancellation of seat.

Signature of the Candidate

l,Mr/Mrs. _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ Parent of

Mr/Ms. Selected for MBBS/BDS Course for the year

2023-24 under Management Q uota declare that my Son/ Daughter is not admitted in any other
Medical College in the country as on today. My Son / Daughter not a part of any seat blocking
procedure. Candidate will not discontinue the course without valid seat allotment at a later date
in other college. In case of any discrepancy we are liable for legal action by KNR University of
Health Sciences and Government and cancellation of seat.

Date(DD/MM/YYYY): Signature of Parent

 Annexure -VII

DECLATATION
(T his declaration is to be given by a student/pa rent/Blood R elative (family member) who is seeking

Admission under NRJ category (Management· quota of NRI)

I , Mr/ Ms ................... . .. . ........................................ NEET -2023 UG Roll No .. .. ............... ..

Rank NEET-2023(UG) ..... ............... ........ ...Son/daughter of Mr /Ms ......... .. .. ... ................. .. .

Seeking admission into UG course in Management Quota (NRI quota seats) for the academic year 2023-2024
into ............. ............ .......... ................... ..... .... .... ........................................... ..college of

Telangana Private Noll-Minority /Minority Medical Colleges do hereby declare and state as under.

I declare that , I am Son/Daughter/Niece/Nephew/Brother/ Sister of Mr/Ms ......... . ..... ............ .. ... . .... .

S/o D/o .. ... ............... .. ... .. ............... .. . .. ......Rio ............. ........... ........ .. ...... ............. ...... .. ..

(here incorporate the complete address of NRl to whom the candidate is related}.

J declare that lhe said family member NRJ is paying m y fee for my UG course and I further declare that the

above facts stated arc true and correct and I am liable for any action in the event of concealmeDt of facts.

Hence, this declaration.

(Signature of the Candidate)

I , ........ .... . .... .... ............... .. .......... ..... ....... ..S/ o here declare and confirm that the above candidate viz ,

Mr/Ms ...... ......................................... . . .... ......... is related to m e as Son/ Daughter/ Niece/ Nephew/

Brother/ Sister and I hereby irrevocably agree and undertake to provide financial support to lnim/ her by

payment of entire fees and other expenses for pursing UG course in the Medical College of Telangana State

underKNRUHS.

Date: (Signature of the N RJ)

- - - - - - - - - E ND- - - - - - - - - - -
B.G.No.:
Date of Issue:
B.G. Amount: Rs: /-
Date of expiry: 30/06/ 2024

IRREVOCABLE BANK GUARANTEE

We, _ _ __ _ __ _ __ Bank, having its Branch at

_ _ __ _ __ _ __ __ _ _ [hereinafter to be referred as ' BANK1 do
hereby issue this Irrevocable Bank Guarantee at the request, upon application
and on behalf of Mr./Ms. _ _ __ __ ___, S/o / D/o
[hereinafter to be referred as 'STUDENT'] in
favour of (College Name with full address), represented by its Kamineni
Academy of Medical Sciences and Research Centre, L.B Nagar, Hyderabad,
Telangana [hereinafter to be referred as ' BENEFICIARY' "INSTITUTE]".

WHEREAS the above named Student got admitted into p t MBBS Course
for the academic year 2023- 24 and paid the p t year fee of Rs. .. ../-.
(Rupees ........................................................................................................ ) and is also
obligated to pay the fees of Rs. / - for the remaining period of the
course as follows on -

1. Second year fee payable on or before p t JUN - 2024, Rs. I-

(Due date of Payment of Fees)

2. Third year fee payable on or before p t JUN - 2025, Rs. /-

(Due date of Payment of Fees)

3. Fourth year fee payable on or before 1 st JUN - 2026, Rs. /-

(Due date of Payment of Fees)

4. Fifth year fee payable on or before 1st JUN - 2027, Rs. /-

(Due date of Payment of Fees)

Pee,- 1 el l
 WHEREAS as per the conditions for admission, the Student is required to
furnish an I rrevocable Bank Guarantee to the Beneficiary from any Nationalized
Bank to protect the interest of the Beneficiary in the event of any default of the
Student in payment of balance fee as above during the entire course.

Hence in the event of default on the part of the Student in payment of fee
of Rs. / - per year for 2nd year period i.e. 1st Jun 2024, Rs. /-
(Due date of Payment of Fees)

or any part thereof during the balance course period of MBBS, the Bank on
behalf of the Student hereby irrevocably, unequivocally and unconditionally
agrees and undertakes to pay forthwith the said sum of Rs. / - or part
thereof to the Beneficiary without any condition, protest, demur or proof and
without reference to any consent of the Student and irrespective of and not
withstanding any contest / objection from the Student or the existence of any
dispute between the Student and the Beneficiary upon the Beneficiary invoking
this Bank Guarantee with the Letter of Invocation for any part amount of the
bank guarantee to the bank. The Bank agrees to make the payment of invoked
amount to the Beneficiary simultaneously on the Beneficiary submitting the
Letter of Invocation for any part amount of the Bank Guarantee.

Not with standing anything contained herein, the bank further under takes
to pay the full amount of the bank guarantee to the beneficiary without any
reference to the due date of the payment of the fee structure as mentioned in
the guarantee, simultaneously on the beneficiary submitting the letter of
invocation along with the original bank guarantee.

The Bank further agrees that this Guarantee shall constitute an

Independent and autonomous contract between the Bank and the Beneficiary
and shall not in any way be affected by any dispute or difference between you
viz. , the Beneficiary and the Student of whatsoever nature.

Finally, the Bank confirms that a mere letter from the Beneficiary that
there has been a default on the part of the Student in payment of the fees, shall
without any other or further proof be final, conclusive and binding on the Bank

hn l ofJ
to treat the same as a valid invocation along with submission of t he original
Bank Guarantee for making the simultaneous payment of the demanded amount
up to the maximum of Rs. /-
and all claims should be received by the Bank on or before within three
months from the said date.
The Bank's liabilities under this guarantee is restricted to Rs. /-
(Rupees: ...................................................................... Only) and the guarantee shall
remain in force up to dt. 30/ 06/ 2024. Unless a claim is made on the Bank within
three months from the said date i.e.30/ 09/2024 all the claims rights and interest
etc. Whatsoever of the Institute Kamineni Academy of Medical Sciences and
Research Centre, LB Nagar, Hyderabad, under this guarantee shall be lapsed
and shall have no right to enforce this guarantee and the Bank shall be relieved
and discharged from all liabilities there from.

Notwithstanding anything contained Herein:

A. Our Liability under this Bank Guarantee shall not exceed

Rs... (Rs . ............................................................. On ly).
B. This Guarantee shall be valid up to 30 / 06/ 2024
C. We are liable to pay the guarantee amount or any part thereof
under this Bank Guarantee only and only if you serve upon us a
written claim or demand received by us on/ or before 30 / 09/2024
(Date of expiry of claim period of guarantee).

Dated :

THE BRANCH MANAGER,

_ _ _ BANK, _ _ _ _ _ BRANCH.

h crJofJ