M.B.B.S.

 

CHHATRAPATI SHAHU JI

MAHARAJ UNIVERSITY

KANPUR

 

.............................................................................

The stamp of the name of the Exam. should be

affixed on the space provided above by the Institute

 i.e. First Provisional etc. 

Enrolment No. K .......................... Roll No. ....................

(The candidate is required to fill in the form neatly and legibly in his own handwriting)

.....................................................Professional Examination ..................................................... 20


To reach the Registrar's Office one month before the commencement of the Examination.

 

To,

The Registrar Chhatrapati Shahuji Maharaj University

Kanpur

 

Sir,

To be filled in by the University Office:-

Examination fee including marks fee:

** Rs. ...................................received and entered at 

Receipt No. ...............................of the Receipt Book.

Dated .......................................

 

Cashier

CSJM University

 

I request permission to present myself at the ensuring .......................................Professional M.B.B.S. Examination. The required certificates and particulars are forwarded herewith. The Examination Fee of Rs. .......................................including marks fee of Rs. 10/- is forwarded herewith.

 

Date .......................................

.......................................

Signature of Candidate in full 

GSVM Medical College, Kanpur

 

 

PARTICULARS TO BE FILLED IN BY THE CANDIDATE

*Name of the candidate in Hindi .............................................................................
*Name of the candidate in English (Block Letters) .............................................................................
Permanent Address .............................................................................
Local Address .............................................................................
Father's Name    Occupation .............................................................................
Whether the candidate comes from a rural or urban area .............................................................................
Length of residence in UP .............................................................................
Married, Bachelor or Widower .............................................................................
Date of Birth (according to H.S. Certificate) .............................................................................
If migrated from any other university mention whether migration certificate of the University last attended deposited in the College or not .............................................................................
Date of admission in the College .............................................................................
Particulars of the qualifying  1. Name of the Exam...............................................
examination passed 2. Month...............Year.............Roll No. ..................
1. CPMT or CBSE for Ist Prof. 3. Subjects............................................................
2. Ist Prof. passed for IInd Prof. ............................................................................
3. IInd Prof. passed for Final Prof. ............................................................................
Whether the candidate has appeared for the Examination in a proceeding examination and is exempted from appearing again in any subject...................................................................................................................................................
...................................................................................................................................................................
Subject:
  1. ....................................... 
  2. ....................................... 
  3. ....................................... 
Month of passing
  1. ....................................... 
  2. ....................................... 
  3. ....................................... 
  4. ....................................... 
Subject or subjects in which he is examined  1....................................... 
2.......................................  3....................................... 
4.......................................  5....................................... 

*Notes :  

  1. Woman candidate must write Km. or Smt. before her name.
  2. Woman candidate must submit the requisite affidavit suly sworn in before a fist class magistrate is case there is a change in her name due to marriage.
  3. This should be spelt very accurately, as this is to be written in the Degree.

Ist Professional Rs. 270/-, IInd Professional Rs. 320/-, Final Professional Rs. 320/-

(Declaration to be signed by the candidate)

Declare that 

  1. I have read the rules relevant Ordinance statutes etc, and undertake to abide by them and will not claim any benefit arising out of some error or mistake on the part of the University.

  2. I am not appearing at any other examination of the University not allowed under the Ordinances.

  3. I have not been debarred from appearing at any examination by the University, on account of use of unfair means or any other reason.

  4. I will have no objection to my person being searched by any one deputed by the Superintendent of the Examination or the Vice-Chancellor/Registrar, CSJM University, Kanpur during the course of or before the examination.

....................................... 

(Signature of candidate in full)

CERTIFICATE

(The certificate is to be signed by the Principal of the College at which the candidate had studied)

I certify that the above named candidate has been duly enrolled as a member of the CSJM. University, Kanpur. That he/she has fulfilled the requirements prescribed by the Ordinances of the University regarding admission to examination in the faculty of Medicine, that I know nothing against his/her character which may debar him/her from the examination, that he/she not been debarred from appearing at the ensuring examination on use of unfair means charge and that I believe the subjoined account to be true.

I also certify that on the basis of the attendance recorded upto date, the candidate will be able to fulfill the attendance requirements prescribed by Ordinance of the University by regular attendance for the rest of the session. The irregular case shall be reported to the University in the prescribed froms for necessary action.

 

Date ...........................

......................................  

Signature of the Principal

Seal of the College

In the University Office:

Enrolment Checked by........................... 

Scruitinised by......................................

 RULES FOR THE GUIDANCE OF CANDIDATES

  1. The doors will be opened on the first day half an hour before and on the other days fifteen minutes before the time fixed for the commencement of the examination and will be closed punctually on each day at the fixed time, after which no candidate will be admitted.

  2. A seat, which a number corresponding to that on the Admission Card he/she has received will be allotted to each candidate and book in which to write his/her answer will be supplied by the Invigilator on duty. Candidates will be required to find and occupy seats allotted to them.

  3. The order in which the candidates are seated will be recorded in the University Office. Should any candidate be discovered to have occupied from another, both parties will be excluded from the examination.

  4. No candidate without the special permission of the invigilators/incharge should leave his/her seat of the examination room untill the end of the examination.

  5. Candidate should not leave the hall without handling over their answer books to the Invigilator/Incharge.

  6. Each candidate will write on the cover of the answer book his/her Roll Number, Enrolment Number etc.

  7. All candidates are required to provide their own pens.

  8. Candidates are forbidden to write answer (or anything else) on the question paper or on the blotting paper.

    1. Candidates are forbidden to sign their names in any part of their answer books. They must put down the word "THE END" at the end of the their last answer.

    2. Candidate are wanted against writing their Roll Number, Names, Enrolment Number or make any other sign or make inside their answer book. Any breach of the instruction is liable to be penalized.

  9.  No book or notes or printed or manuscripts sheets of papers, should on any account be brought into the examination room in which the candidates are seated. Candidates found in possession of them or found using or attempting to use any other unfair means will be punished according to the rules of the University.

  10. Candidates will be required to sign their names when directed to do so by the officer-in-charge.

  11. No guarantee is given to candidates regarding the order of the question papers. 

  12. a duplicate copy of the Admission Card is issued on receipt of an application along with a fee of Rs.1/-.

  13. Candidate appearing at the examination of the University are under the disciplinary control of the Superintendent of the center and they are required to obey his instructions.

  14. Candidates must write on both sides of the paper in their answer books, any rough drafting, calculations etc. may be made and crossed out and these will not be red by the examiner. No loose paper is allowed.

  15. In the Examination Room the candidates may be required to give physical search, when asked for it, by the members of Flying Squad or any member of Superintending Staff of the examination centre cencerned. If a candidate refuses to give search he is to such punishment as the University deems fit.

  16. Candidates will be required to sign an attendance sheet on every day of the examination that they appear at.

  17. No enquiries by telegram or post concerning result will be answered by the Registrar. Candidates must wait for the announcement of the results in the News Papers.

  18. Candidates found to have approached their examiners will be seriously dealt with. Examiners have been instructed to report all such to the Vice-Chancellor.

Chhatrapati Shahuji Maharaj University

Kanpur   

REGISTRAR