TERNA PUBLIC CHARITABLE TRUST’S
TERNA MEDICAL COLLEGE & HOSPITAL
Sector –12, Phase –II, Nerul (W), Navi Mumbai – 400 706,Maharashtra ,India
Ph.+ 022-27720563/ 27723664 / 27721442 Fax + 022- 27716314
E-mail : website:-ternamedical.org
ANNEXURE-“F”
PROFORMA (Undertaking)
Undertaking by student seeking admission
On stamp paper of Rs.100/-
UNDERTAKING
I,______S/o ______of Mumbai, Indian Inhabitant, residing at ______do solemnly affirm and state as under:
1. I say that I have appeared for the Asso-CET 2015 examination conducted by AMUPMDC to secure admission in the academic year 2015-16 in Medical/Dental Colleges.
2. I say that solely on the basis of merit I have been admitted to the Terna Medical College in 1st year MBBS Course.
3 I say that at the time of obtaining my admission I have paid a sum
of Rs.______/- as fees for 1st year MBBS Course.
4. I say that I am fully aware that the aforesaid fees paid by me are interim fees and
are subject to revision at any time. In the event of the fees being increased by
the Shikshan Shulka Samiti or Judicial Pronouncement, I hereby undertake to
pay the difference amount of the fees within a period of 7 days from being
notified.
Solemnly affirmed at Mumbai
This ______day of ______2015 Before Me
[ Identified by me:______
NOTARY
ANNEXURE “K”
Proforma (Undertaking)
Undertaking by student seeking admission
(Rs.100 Stamp paper)
UNDERTAKING
Name of Student :
Roll No. :
Year of Study :
Hostel Room no. (if any)
I______S/O ______of Mumbai, Indian inhabitant residing at (Permanent address) ______do solemnly affirm and state as under :
1. I have a local guardian Shri ______residing at ______phone no.______, who can be contacted if required.
2. I say that solely on the basis of merit I have been admitted to the______college in Ist Year ______course in the year ______.
3. I say that I have read the relevant instructions and guidelines / rules against ragging and consequences of indulging in ragging as well as the punishments under the rules of the ragging issued by the competent authorities from time to time.
4. I am submitting herewith a character certificate from my College (specify Name of College last attended)______mentioning the status of my behavioural pattern specifically in terms as to whether I have displayed persistant violent or aggressive behaviour or any desire to harm others.
5. I, the parent / guardian of the student, say that I have gone through the relevant instructions/regulations against ragging as well as punishments and that if my ward has been found guilty, he / she shall be proceeded against, shall be prosecuted.
6. I have taken / not taken the admission in the college hostel and I will be abide by the rules and regulations of hostel and as well as anti ragging rules issued from time to time by government, court and college authorities.
7. Some of the relevant Provisions of ragging and Punishment to be awarded are furnished below :-
All students are informed that RAGGING in educational institution have been prohibited by Maharashtra Government under the Maharashtra Prohibition of Ragging Act, of 1999. Any student or group of students, doing any act which causes or is likely to cause physical or psychological harm or raise apprehension or shame or embarrassment to a student in the college, will be convicted. It includes teasing , abusing, threatening or playing practical jokes or causing hurt to such student or group of student or (ii) asking a student to do any act or perform something which such student will not in ordinary course willing to do.
Any student directly or indirectly commits / participates in, abets or propagates, ragging within or outside the college premises shall, on conviction, BE PUNISHED WITH IMPRISONMENT FOR A TERM EXTENDED TO TWO YEARS AND SHALL ALSO BE LIABLE TO FINE WHICH MAY EXTEND TO Rs.10000/-.
ANY STUDENT CONVICTED OF AN OFFENCE UNDER SECTION 4 (RAGGING) BE DISMISSED FROM THE COLLEGE AND SUCH STUDENT SHALL NOT BE ADMITTED IN ANY OTHER INSTITUTION FOR A PERIOD OF 5 YEARS from the date of dismissal order.
Name & Signature of Parent Signature of Candidate
1. Local Address
(In case of outside students staying
independently by hiring room/ private hostel, Dhramshala etc.)