(7) All Candidates selecting Government seats {including All India quota (AIQ) in Post Graduate

Medical Courses shall furnish an undertaking that he shall serve the Government for a minimum
period of three years after completion of the course, if Government desires:
Provided that, in-service candidates at the time of admission shall furnish a bond in the form
specified by the Government that they shall be rendering service in the Government for a minimum
period of ten years.

(8) In case of candidate selecting Government seats, the candidate shall serve the Government for a
period as specified in sub-rule (6) failing to comply, with the conditions given as per
undertaking, then he shall be liable to pay a penalty of Rs. 50,00,000/- (Rupees fifty lakhs only)
in case of Post Graduate Medical degree and Rs. 25,00,000/- (Rupees twenty five lakhs only) in
case of Post Graduate Medical Diploma to the Government.
(9) Any cancellation or surrender shall be done at the Directorate of Medical Education after the last
date of admission for that academic year.

NOTE: The candidates are advised to strictly adhere to the above said rules. Lenience in any matter
explained above will not be entertained. The Government/Department of Medical Education
/ KEA hold all the powers to cancel the candidature of candidates who do not comply with
the rules and regulations.
Admission to PG Medical and PG Dental seats shall be made in accordance with the Karnataka
Conduct of Entrance Test for selection and admission to Post Graduate Medical and Dental Degree and
Diploma courses Rules, 2006 (Amendments) as amended from time to time and therefore the details and
instructions contained in this Information Bulletin are subject to the said Rules and Government orders.
In case of any discrepancy, the Rules shall prevail.

16. ANNEXURES
16.1. Compulsory Rural Service Bond
16.2. Service bond for selected candidates for collecting admission Order
16.3. NBE Notice for Qualifying NEET-PG 2024
16.4. NBE Notice for Qualifying NEET-MDS 2024
16.5. Internship completion Certificate
16.6. Provisional Internship Completion Certificate
16.7. Affidavit
16.8. Reservation under 371(j) (Hyderabad Region)
16.9. Linguistic Minority Certificate BEO
16.10. Linguistic Minority Certificate PUC
16.11. Proforma for Study Certificate
16.12. Religious Minority Certificate
16.13. St. Johns Medical College Format 3
16.14. St. Johns Medical College Format 1 & 2
16.15. St. Johns Medical College Format 5
16.16. St. Johns Medical College Format for PG category
16.17. NRI ward Format
16.18. MCC Notice dated 12-07-2024
16.19. Document verification schedule for PG medical and PG dental
16.20. NMC Notice dated 24-07-2024
 ANNEXURE-1

Compulsory Rural Service Bond Format for non in-service Candidates

(To be executed on a stamp paper of Rs. 100/- and duly notarized)

(To be submitted by all the category candidates allotted to Government or Private or

Deemed colleges under Government quota or Private quota or NRI quota or Management
quota)

(To be submitted at the time of collecting admission order at KEA)

I ------------------------------------------ aged ––––––––––––––––––––––––S/o, D/o, W/o-------------

------------------------------------------------------- Permanent Resident of -----------------------------------
---------------------- at present residing at -------------------------------------------------------------- (as
per address document submitted along with application), do hereby swear on oath as
follows;

1. That I am admitted to ----------------------------------------------------------College for PG / Broad-

specialty /Degree / Diploma in --------------------------------- (mention the subject) under ----------
------------------------------------------- quota.

2. I am submitting the bond after reading and fully understanding the Karnataka Compulsory
service by candidates completed Medical course act 2012 and its amendments.

3. I state that I have admitted under non-in-service State quota / All India quota.

4. I understand that all the candidates (other than the candidates who have undergone
compulsory rural service after award of MBBS degree) who take admission to PG Medical
Degree/Diploma courses and successfully complete the Post Graduate Degree/ Diploma
shall under go one-year compulsory service in Government hospital in urban area as per
Karnataka Compulsory service training by the candidates completed medical courses
(counseling, allotment, and certification) as per Karnataka Compulsory Service Act 2012 as
amended in 22/09/2017 and rules there under to the said act.

5. I am fully aware of the fact that the candidates will be entitled to only temporary
registration until completion of such service. I shall be abide voluntarily to the said
condition.
 Personal Details

(Needs to be submitted by the candidate along with the bond)

SL.
Particulars
No.

1. Name

2. Age with date of birth

3. Fathers Name
4. Mothers Name
5. Present Address
6. Permanent Address

Contact number of the Candidate

7. Mobile :
Landline

Contact No. of
Parent/Guardian/reference of
8.
candidate to contact in case of
emergency

9. E-mail ID
10. Aadhaar No.

State Medical Registration No.

11.
State

12. All INDIA NEET Rank

13. KEA PGET NUMBER
14. Admission order details

Name of the College to which

15.
candidate is admitted

16. UG/Super Speciality / PG / Diploma

17. Discipline / Subject

Details of the reservation quota

18.
under which candidate is admitted
 ANNEXURE-2

UNDERTAKING AS REQUIRED UNDER RULE 15(6) OF THE KARNATAKA CONDUCT OF ENTRANCE TEST
FOR SELECTION AND ADMISSION TO THE POST-GRADUATE MEDICAL AND DENTAL DEGREE AND
DIPLOMA COURSES RULES, 2006 FOR MEDICAL DEGREE / DIPLOMA COURSES

(To be executed on a stamp paper of Rs. 200/- and duly notarized)

I ......................................................................................................................

S/o, D/o, W/o …………………………………………………………………………………

aged …………… years, having Aadhar no......................, PAN No. ....................

permanent resident of ………………………………………………………… (as per address proof

submitted)
and
presently residing at……………………………………................................. (as per temporary address
entered in application), (herein after referred to as BOUNDEN) do hereby swear on oath as
follows:-

1) That I am admitted to Government seats for ‘All India Quota’/‘State quota’ in

………........................................................college for post-graduate medical
degree/diploma in ……………………………… …………………….. (Indicate the subject) during
the centralized counseling for admission to post-graduate courses-2024.
2) I am aware of the fact that the tuition fee for Government seat is highly subsidized, I
shall be under an obligation to serve the State of Karnataka for a minimum period of
three years after completion of my post-graduate course as required under rule
15(6) of the Karnataka conduct of entrance test for selection and admission to the
post-graduate medical and dental degree and diploma course rules, 2006. After
reading and fully understanding the abovementioned Rules, I have opted for the
“Government’ seat”.
3) In compliance with the above Rule 15(6), I hereby furnish the undertaking
voluntarily, with my free will that I shall abide by the condition to serve the
Government of Karnataka for a period of three years after completion of my post-
graduate course in any location decided by the Government of Karnataka, and that If
I fail to comply with undertaking, myself and/or my sureties mentioned below do
hereby bind ourselves and each of us, our and each of heirs, executors and
administrators jointly and severally to pay to the Governor of Karnataka on demand,
we shall pay a penalty of Rs. 50.00 lakh (RUPEES FIFTY LAKH ONLY) for post-graduate
degree and Rs. 25.00 lakhs (RUPEES TWENTY FIVE LAKH ONLY) for post-graduate
diploma to the Government and only after payment of penalty, I shall collect my
original documents which are in the custody of the Institution.
 4) I am enclosing the details of two sureties along with their self- attested copies of
PAN card and Aadhar card.

Signed this day of ................................., by the Bounden

DETAILS OF SURETIES
1. Name : ....................................................................................S/o, D/O, W/o
……………………………………. aged …………… years, having Aadhar no...............,
PAN No…………........permanent resident of ……………………… ………………
………………… and presently residing at ……………………………………..................,

2. Name: ....................................................................................S/o, D/O, W/o

……………………………………….aged …………… years, having Aadhar
no………............., PAN No. .................... permanent resident of
…………………………………………………… and presently residing at
……………………………………..................,

BOUNDEN SURETIES

1.

2.

WITNESS
1.

2.
ANNEXURE-3
ANNEXURE-4
 ANNEXURE-5

Internship completion Certificate

Ref. No………….. Vol:………………..

Page: ……………. Sl.No………………

This is to certify that Dr……………………………………………………………………was a bonafide student of this

institute from …………………………………to ….……… …………...while pursuing M B B S course. He/She has
passed the final M B B S Examination………………………….……of ……………..……….………..University held
during………………………………………………………and the medium of instruction is English.

He / She has satisfactorily completed the compulsory Rotatory Internship Training Programme (One
Year) as a resident intern from………………………….to ………………………..with Provisional Registration
No………………………. of Karnataka Medical Council.

The details of postings as resident intern in the teaching Hospitals attached to ……………………………...
is as here under:-

Discipline Period Extension if any

A. Medicine and Allied Specialties

I. General Medicine including psychiatry 2 Months ……………………

II. Pediatrics 1 Month ……………………
III. Skin & STD 15 days …………………...
IV… …………………………………… 15 days ……………………

B. Surgery and Allied Specialties

I. General Surgery including Anesthesia 2 Months ……………………

II. Orthopedics including PMR 1 Month …………………...
III. Ophthalmology 15 days ……………………
IV. E.N.T 15 days ……………………
V. Casualty 15 days ……………………
VI. …………………………………… ……………………
C. Obstetrics & Gynecology
Including Family Welfare 2 Months ………………….

D. Community Medicine
Including Rural Health Training 2 Months ………………….

He / She is eligible for the award of M B B S degree from …………………University. His / Her work,
character and conduct during the stay in the institution were found to be of good as per records.

Seal: Director/Principal
 ANNEXURE-6

PROVISIONAL INTERNSHIP COMPLETION CERTIFICATE

(On the letter of the Medial / Dental college studied)

Ref. No. Date: ………………..

To Whomsoever It May Concern

This is to certify that Dr. ………………………………………………………………….

is a Bonafide Student of this Institute from ……………………….. to ………………….

He has begun his internship from …………….. and is likely to complete his /her compulsory Rotatory
Internship Training Programme (One Year) on …………………….

Signature of the Principal

with college seal

 ANNEXURE-7

(To be submitted on Rs. 20/- Bond paper at the time of admission)

Affidavit

I,
Dr…………………………………………………………...………………………………………………………………………………………..s
on /daughter of .………………………….………
…………………………………..………………………………………….……………..residing at
……………………………………………………………… have appeared for NEET-PG 2024 / NEET MDS 2024 conducted
by National board of Examinations, New Delhi and have been declared as qualified with a total score
of secured …….. …………score in the said test.

I hereby solemnly declare that I have not taken post graduate admission in any college allotted by
other exam conducting bodies. I have not surrendered any seat in past NEET-PG 2024 / NEET MDS 2024
exams/other post graduate entrance exams conducted by 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 only at Karnataka Examinations Authority, Bangalore.

I shall produce all the required original documents for verification and submit the same as notified
by Karnataka Examinations Authority.

I shall not produce/submit fake/concocted documents for verification or admission.

I will forfeit the seat allotted to me and I am also liable for criminal proceedings if any one of the
above information/documents produced by me is found to be false/incorrect.

PGET No. / Testing ID.

Date:

PLACE

Deponent

Signature of the Candidate Sworn Before Me

 ANNEXURE-8

[Under Article 371 (j)]

(see rule 3(3))

[The Karnataka Public employment (Reservation in Appointment

for Hyderabad-Karnataka Region) Rules

for issue of Certificates, 2013.]

Sri / Smt…………………………….………………………………….……… …………… ……… S/o / W/o

…………………….………………………………………………………….is a Local Person of the Village / Town

………………………………………….……………………. of Taluka ……………………… ……………. of the district of

Karnataka State.

Place: ……………………………. Name: ………………………………

Date: …………………………….. Assistant Commissioner

……………………………….. Sub Division

……………………………….. District
 ANNEXURE-9
(For 1st to 10th Std. in Karnataka)
PROFORMA FOR LINGUISTIC MINORITY CERTIFICATE
(Government Order No. ED 165 Mahiti 2018, dated 12-09-2018 - ANNEXURE-5)

(This Certificate is issued for the purpose of seeking admission to Under Graduate / Post
Graduate Medical / Dental Courses for the Year…………………..)

This is to Certify that Kum / Sri/ Smt …………………………… …………… …………………. Son/ Daughter
of……………………….…… …… …… ……………… ……….. has studied from
…………………………………………..to ………………………………………..in institution located at ………………
…………………

Mother Tongue of the student is …………………………………………………as per the admission

register maintained in the institution.

Therefore, he / she belongs to……………………………Linguistic Minority

Institution Seal Signature of Head of the Institution

(Name in Block Letters)

Place:…………………… …………………….Taluka

Date:……………………. …………………….District.

Counter signed by Block Education officer

Signature & seal of the Concerned

Block Education Officer

Date:…………………………
 ANNEXURE-10

(For 1st PUC and 2nd PUC or 11th and 12th Std. in Karnataka)
PROFORMA FOR LINGUISTIC MINORITY CERTIFICATE
(Government Order No. ED 165 Mahiti 2018, dated 12-09-2018 - ANNEXURE-5A)

(This Certificate is issued for the purpose of seeking admission to Under Graduate / Post
Graduate Medical / Dental Courses for the Year…………………..)

This is to Certify that Kum/ Sri/ Smt ……………… ………… …………………………………. Son/ Daughter
of……………………….………… ……………………………..has studied from …………………………..standard
to…….………………………..from…………………… ……. …………………to
…………………………………..in……………………………….. institution located at…………………………………

Mother Tongue of the student is …………………………………………………as per the admission

register maintained in the institution.

Therefore , he / she belongs to ……………………………….. Linguistic Minority

Institution Seal Signature of Head of the Institution

(Name in Block Letters)

Place:…………………… .…………………….Taluka

Date:……………………. …………………….District.

Counter signed by Deputy Director, Pre-University

Signature & seal of the Concerned

Deputy Director, Pre-University

Date:…………………………
 ANNEXURE-11

PROFORMA FOR STUDY CERTIFICATE

NAME, FULL POSTAL ADDRESS & TELEPHONE NUMBER OF THE INSTITUTION.
Date ….…...............

This is to certify that Sri. / Kum. ...............................…………. S/o / D/o

..........................……..............…….. has studied from ..............…......... standard to
………..……............. standard in our institution from …………………...... to ………..……........
academic years. The mother tongue of the candidate is ……………………………… as per the
Admission register of the institution. The above details are true and correct to the best of
my knowledge.

Signature of Head of the institution with Institution seal

(Name in Block letters..........................................)

Mobile number:

COUNTER SIGNED BY ME

Address, Seal & Office Telephone Number

of the Block Educational Officer / DDPU.
Mobile number:

Note:

1) Counter Signature of BEO / DDPI is required for 1st to 10th standard only ( For CBSE / CISCE
students Signature of the Head of the institution ).
2) For 11th standard and 12th standard / MBBS / BDS Study certificate seal and signature of the
Principal / Any Gazetted officer is sufficient.
3) The above Proforma for study certificate is only template; the same can be modified by the
candidate for the class from 11th standard and subsequent studies.
4) The same proforma may be used for parent’s study certificate.
 ANNEXURE-12

PROFORMA FOR RELIGIOUS MINORITY CERTIFICATE - ANNEXURE-IV(A)

(Government Order No. MWD 330 MDS 2018 Bangalore dated 13-06-2018)

This is to certify that Kum / Sri / Smt ……………… …………………… ……………………..… Son /
Daughter of …………………………… ………………… ………………….…. has studied from
……………………………. Standard to……………………….…………………… Standard from …………… to
…………… in ……………………………………………………………………………….. institution located
at…………………………………………………………………………..……….. He / She belongs to
……………………….. religion.

This Certificate is used for the purpose of seeking admission to under Graduate / Post
Graduate Medical / Dental Course for the year …………………….

Name :…………………………..

Tahsildar

Place :………………….. ………………………….Taluka

Date:………………….. ………………………….District
 ANNEXURE-13

CERTIFICATE FORMAT FOR PG CATEGORY - 1

(ON OFFICIAL LETTER HEAD OF THE Superior General / Provincial)

Ref No Date:………

CERTIFICATE

This is to certify that Dr. Sister …………….………………………….., KEA Application Number

___________________________ is residing at _____________________________________

_________________________________________________________________________ is

a bonafide Professed Religious in the _________________ providence of the Roman

Catholic congregation of __________________________________________ in the Roman

Catholic Diocese of _________________________ in the state of _____________________.

I further certify that Sr. __________________________________________________ has

been permitted by the Province / Congregation to apply for MD / MS admission to St. Johns

Medical College, Bangalore.

Name and signature

Provincial Superior /Superior General

Official Seal
 ANNEXURE-14

CERTIFICATE FORMAT FOR PG CATEGORY 1 AND 2

ST.JOHN’S STUDENTS WITH RURAL SERVICE

ELIGIBILITY CERTIFICATE FOR ST.JOHN’S STUDENTS WITH RURAL SERVICE (ON OFFICIAL
LETTER HEAD OF DIRECTOR OF ST JOHNS ACADEMY OF HEALTH SCIENCES)

Ref No Date:

This is to certify that Dr. ________________________________ MBBS Graduate

(________ year batch) of this institution has done two years of rural service as required
by the social obligation service executed by him / her at the time of his / her admission
to St John’s Medical College.

Dr. _______________________________________________________ is eligible for PG

admission 2024-25 in St John’s Medical College, Bangalore under Category 1 (Roman
Catholic Religious Nuns with SJMC approved rural service) or Category 2 (SJMC Alumni
with SJMC Rural Service)

Rural Medical Center Period of service

Postal address of rural center to

Director, SJNAHS.
 ANNEXURE -15

FORMAT OF PG CATEGORY - 3

(ON OFFICIAL LETTER HEAD OF THE PARISH)

BAPTISM CERTIFICATE

NAME: ……………………………………..SEX: ………… BORN ON: ……… …… AT………………………

BAPTISED ON ………………………………… AT……… …… …………. NAME OF THE
FATHER………………………………………………

NAME OF THE MOTHER……………………………………………………

RESIDENCE AT THE TIME OF BAPTISM……………………………..

GOD FATHER…………………………………………………

GOD MOTHER………………………………………………..

MINISTER OF BAPTISM……………………………………

CONFIRMED………………………………………MARRIED……………….

Certified to be true copy of an entry in the Baptism register kept on…………………..

Date:………………. Signature of Parish Priest with seal

ANNEXURE -16

CERTIFICATE FORMAT FOR PG CATEGORY 3

ROMAN CATHOLIC CHRISTIAN ALL INDIA OPEN MERIT

ELIGIBILITY CERTIFICATE FOR ROMAN CATHOLIC CHRISTIANS ALL INDIA OPEN MERIT

This is to certify that Dr (candidate name) KEA application number (application number)
residing at (candidate permanent address) is a bona-fide Roman Catholic Christian belongs
to the (name of the parish) parish in the Diocese / Archdiocese of (name of the diocese) in
the state of (name of the state)

Name, Signature of the Bishop of the

Applicant’s Diocese With official seal
Date:
 ANNEXURE -17

Ward Certificate (children of Non-resident Indian or their wards)

For admission under NRI Quota seats

I, (name of Guardian) ____________________________________________________________ son

of Sri / Smt._________________________________________________ aged __________ years
(Date of Birth) __________ Holding an ___________________________ Passport and residing at
_______________________________________________________________________________
_________________________________________________________________________________

Telephone No.________________ Mobile No._______________ e-mail ID: _________ ________.

I do hereby solemnly affirm and state that, Sri / Kum__________________________ _________ S/o
/ D/o of ________________________________________________ who is seeking admission to Post
Graduate Medical / Dental courses through KEA for the year 2024-25 is my "Ward".

I would wish to state that I am the guardian of the said candidate for the entire course of study
and will be legally responsible for his/her Post Graduate study.

Passport Details.

Passport No. ______________ Place of issue ___________

Date of Issue. _____________ Date of Validity of Passport ________

Bank Account Details

Nature of Account _______________________________

Name of the Bank and Address __________________

Relationship with the student ____________________ (Relationship of NRI with the candidate as
per the court orders of The Hon’ble Supreme Court of India in case W.P.(c) No. 689/2017-
Consortium of Deemed Universities in Karnataka (CODEUNIK) & Ans. Vs Union of India & Ors. dated
22-08- 2017.)

(Signature of the Guardian)

Date: Place :________

Embassy Seal and Signature of the Competent Authority.

(Embassy certificate of the Sponsorer (Certificate from the Consulate issued within last 06 months)
should be enclosed separately.)
 ANNEXURE -18
GOVERNMENT OF INDIA
DIRECTORATE GENERAL OF HEALTH SERVICES
Office of MCC of DGHS MINISTRY OF HEALTH & FAMILY WELFARE
NIRMAN BHAWAN, NEW DELHI-110108
Email: [email protected]

Ref.U-12024/01/2023-MEC Dated: 12-07-2023

NOTICE
Urgent Attention all Participating States/Counselling
Authorities and Candidates:
In compliance of the directions of the Hon’ble Supreme Court of India
vide Order dated 31/03/2023 in W.P. (C) No. 174 of 2023, Medical
Counseling Committee of DGHS, MoHFW has developed a software for all
the participating states/counseling authorities for NEET-UG/PG to upload
the names and roll numbers of students who have joined up to round 2
and further rounds of the state quota or round 2 of the AIQ on the
common portal.
These joined candidates up to round 2 of AIQ or State Quota shall not be
eligible to participate in the further rounds for All India Quota or for State
Quota from the academic year 2023-24 onwards.

Notice posted on: 12.07.2023

 ANNEXURE-19

DOCUMENT VERIFICATION ONLY FOR PG NEET MDS - DENTAL

The candidates who have registered through online and paid the registration fees are
only eligible to participate in the document verification process with all the necessary original
documents. Please read the previous pages regarding submission of original documents during
document verification. Candidates have to be personally present for the verification of
document at KEA, 18th Cross, Malleswaram, Bangalore on the basis of NEET PG MDS – 2024
All India Rank.

OFFLINE DOCUMENT VERIFICATION WILL BE CONDUCTED AT KEA, 18TH CROSS,

MALLESHWARAM, BANGALORE.

The candidates should not produce laminated academic marks cards / formats / certificates
for verification, KEA will not verify the marks cards which are laminated; and such candidates will not
be eligible for further process of seat allotment.
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INSTRUCTIONS
1. Mere qualifying in NEET-PG 2024 / NEET PG MDS-2024 does not confer any right on the
candidate for admission unless the candidate fulfils eligibility conditions / submits the
documents / certificates. Further, only the candidates who complete the registration process
including document verification are eligible for PG Medical seats in Government / Private
Colleges in Karnataka.
2. Candidates have to appear for verification of documents as per the schedule according to PG
NEET MDS 2024 All India Dental rank in the Centre.
3. Candidates will be allowed to enter the premises in the order of All India Rank and only 15
minutes before the scheduled time; hence candidates are advised to appear as per the
scheduled time.
4. Candidates should compulsorily produce all the required documents in ORIGINAL with two
sets photocopies of all the original documents.
5. The candidates who become eligible after verification will only be considered for entry of
options to become eligible for allotment of seats.
6. Candidates have to be personally present as per the schedule for verifying the documents
and no one can represent them.
7. KEA will publish the details of eligible candidates on the website http://kea.kar.nic.in after
verification.
8. Candidates can bring drinking water bottle with them, candidates may carry some food and
medicines if required.
9. The candidate should bring all necessary original documents with them in support of their
claim / reservation made in their online application.
10. Verification of original documents requires more time for scrutiny of each certificate
produced by the candidate. Hence the process may get delayed. Candidates have to appear
in the order of All India Rank / schedule. Request to verify documents before the schedule
time will not be entertained. Candidates have to arrange their return journey accordingly.
ANNEXURE-21