KHYBER MEDICAL UNIVERSITY

UNDERTAKING / AGREEMENT[1]

(TobefilledbythecandidateonJudicialBondof Rs.30/-anddulyattestedbytheDeputyCommissioner/ PoliticalAgent/DCO/FirstClassMagistrate).

IMr./Miss.______Son/Daughter/Wifeof______Resident of ______

______

Do herebysolemnlyundertaketoabidebythefollowing:

  1. ThatIhavereadtheProspectusof KMU-IMS/IDS, Kohatandherebyagreetoconformtoallprovisionsof thestatutesof theInstituteorstatutesandrulesasmayhereafterbeframedbythe appropriateauthorities.
  2. Thattheinformationfurnishedin,anddocumentsattachedwiththeapplicationform,are correct,andIfullyunderstandthatat anytimeduringthecourseofmystudy,if itisfound thatanyinformationis in-correctoranydocumentproducedat thetimeof admissionis false,whichwouldhaverenderedmeineligibleforadmissionundertherules,mynameshallimmediatelybestruckoff theinstituteroll.
  3. ThatIshall,in casemynameisstruckoffunderclause(ii)above,notbeentitledtoclaim refundof anyfeepaidbyme.In additionIshallpayto thePrincipalasliquidateddamagesattherateof Rs.100,000(oneLac)peryearofmystudiesin KMU-IMS/IDS, Kohat.
  4. ThatIshall,haveminimumattendanceof 75percent,diligentlyapplymyselftoacquireand developtheskillnecessaryforthepracticeandadvancementof mystudyin orderto qualifyforexaminationandI willnotbepromotedtothenexthigherclassunlessIhave clearedallthesubjects.
  5. ThatIshallmaintainidentityasastudentof the institutebywearingInstituteuniform.Ishall participatefullyandwholeheartedlyingamesandextracurricularactivities.
  6. Thathostelaccommodationwillbeprovidedsubjecttoavailability,incaseof non- availabilityof hostelaccommodation,Iwillnotaskforanyaccommodation.
  7. ThatIwillnot indulgeinpoliticsof anytypeandwillnotbeamemberof anypoliticalparty/organization/studentsFederation,holdinga gathering,meetingortakingoutprocession in anypartof Campus.Iunderstandthatmyfailureto observethisclauseof undertaking wouldresultincancellationof myadmission/expulsionfromtheInstitute,andthatthe decisionof theauthoritiesconcernedwillbefinal.
  8. ThatIshallneveruseviolence,threatof violenceandpressurein anydisputewithothers, allmeansandmethodsshallonlybelogic,persuasion,petition,appeal,revision,reviewandotherlegalandpeacefulmethodforsettlementof differencesanddisputes.
  9. Thatinanydisputewithstudents,teachersandemployeesof theinstituteI shallacceptthe judgmentof thecommitteeconstitutedbythe principalfordecisionof settlementof the wrongdoers.
  10. Further,Idoherebysolemnlyundertaketorefrainfrom:-
  1. Doinganythingwhichmaycauseinjuryorinsultto head,teacher,officersandotherstaff of institution.
  2. Holdinga gathering,meetingandtakingoutprocessioninanypartof Campusotherthan areasspecifiedforthepurpose.
  3. Allkindsof unfairmeansin examination.
  4. Allowingorabettingtheentryto thepremisesof the Instituteof expelledstudents,anti- socialelementsorotherswhosepresenceintheCampuscouldcauseconflictamongstthe students.
  5. BringingintotheCampus,consumingor encouragingconsumptionof alcoholicproducts, drugsandnarcoticsandindulginginactsof moralturpitude.
  6. Bringingorkeepinganytypeof weaponswithintheUniversity/ Institutepremises.
  7. Usingoroccupyinganyroomorpartof anybuildingof theInstitutionwithoutlawful authority.
  8. Sublettinganyhostelroomtounauthorizedpersons.
  9. DamaginganyUniversity/Institutepropertyincludingbuilding,equipmentand vehiclesetc. inanymanner.
  10. Indulgingin anyviolentoranyotherunsuitableactivitiesevenoutsidethe Institute,which maybringbadnametotheInstitute.
  11. Fromallsuchactsanddeedsas mightbringdisgraceandbadnametotheInstitute.
  1. IncaseI am reportedto beguilty/ involvedin anyof theaforesaidactivitiesduringmy stayinthemedicalInstitute,theInstituteauthoritiescanrusticatemefromthe Institute temporarilyorexpelmepermanently.I willnottrytocreatelawandordersituationor instigatethestudentsof theInstituteorof anyotherinstitutionagainsttheactiontakenbytheinstituteandfurthermoreIwillnotgoto anyCourtof Lawin thisregard.In caseof myexpulsionfrom InstituteI shallpaytothePrincipalasliquidateddamagesat therateof Rs.100,000(oneLac)peryearofmystudyintheInstitute.
  2. If itisreportedthatI havenothonouredthedecisionof the Instituteauthoritiesas describedabove,I shallbeliableto payRs.2,00,000/-(TwoLac)per yearofmystudyin theInstituteasdamagesto theKhyber Medical University
  3. Incasethereisanydisputebetweenmeononehandandtheadministrationof theInstituteontheotherhandregardingmyinvolvementin adisciplinaryorpoliticalmatterorregardingtheimpositionof anypenaltyordamagesonme,themattershallbe referredtothePrincipal,asthesolearbitratorandhis decisioninsuchcapacityshallbe finalandshallnotbechallengedin anycourtof law.
  4. Iwillabidebythedecisionof theInstituteAuthorities.IncaseIamfoundguiltyof indiscipline,defamation,disrespectof theStaffandotheranti-institutionalactivities,I will abidebytherulesanddecisionsregardingthehousejob.
  5. Iunderstandthatif it is foundthatI wasnotentitledforadmissionaccordingtotheKMU-IMS/IDS, KOHATAdmissionpolicyatanystageof MBBScourseor if it isfoundthatI wasnot entitledfor admissionin preferencetotheothercandidateswhoappliedforadmission,myadmission willstandcanceled.
  6. IsolemnlydeclarethatIdo nothavedoubledomicilecertificate.

Signature of the Student: ______

Name: ______

CNIC No / Computerized Form – B No: ______

Father’s Name:______

CNIC No: ______

Permanent Address: ______

______

Present Postal Address: ______

______

Dated: ______/______/______

KHYBER MEDICAL UNIVERSITY

UNDERTAKING / AGREEMENT[2]

Tobefilledbyfather/mother/husband/guardianof thecandidateonJudicialBondof Rs.30/- andduly attestedbytheDeputyCommissionerPoliticalAgent/DCO/FirstClassMagistrate).

I ______Son/Daughter/Wifeof______andFather/Mother/Husband/Guardianof ______herebyfullyendorsetheundertakinggivenbymySon/Daughter/Wife/Wardandassurethathe /shewillabidebythisundertakingduringhis/herstayin theInstitute.

  1. IalsomakemyselfliabletopayRs.1,00,000(onehundredthousand) peryearof his/ herstudyin theInstituteincaseof anybreachof theabovementionedundertakingbymy Son/Daughter/Wife/Ward,Mr./Miss.______.
  2. I ______Father/Mother/Husband/GuardianofMr./Miss ______assurethatmySon/Daughter/Wife/Wardwillnot indulgeinpoliticsof anytypeandwillnotbe amemberof anypoliticalparty/organization/studentsFederationnorwillhe/ sheattendanymeetingof suchorganizations.Suchinvolvementonhis/herpartmayleadtohis/her expulsionfrom the Institute,andthatthe decisionof the Principalin thisregardwillbefinal.

DEPONENT

Signature: ______

Full Name: ______

CNIC No: ______

Father’s Name: ______

PresentPostalAddress:______

Witness-1 Witness-2

Signature: ______Signature: ______

Name: ______Name: ______

CNICNo: ______CNICNo: ______

Father’sName: ______Father’sName:______

Present/PostalAddress:______Present/PostalAddress: ______

______

Permanent PostalAddress:______Permanent Address: ______

ATTESTED

Signatureand StampofPoliticalAgent/FirstClassMagistrate

KHYBER MEDICAL UNIVERSITY

AFFIDAVIT FOR GUARDIANSHIP

(Tobefilledonstamppaperof anydenomination) (TO BEPRODUCEDONSTAMPPAPER)

I ______Son/Daughter/Wifeof ______do hereby solemnly declare that my father has died in the year ______and ______is myguardian.

  1. Signatureof candidate: ______

Nameof Candidate:______

CNICNo.of candidate:______

  1. Signatureof Guardian:______

Nameof Guardian:______

CNICNo.of Guardian:______

KHYBER MEDICAL UNIVERSITY

CERTIFICATE OF LOCATION OF EDUCATIONAL INSTITUTES

(TobesubmittedbythecandidatesapplyingagainstBackwardAreasandFATAinnerseats)

OfficeofExecutiveDistrictOfficer(Education)District/Agency/FR: ______

Certified that Mr./Ms. ______S/O,D/O ______has beenstudyingintheDistrict/Agency/FRof______as follows:-

Class / FullNameof School/College / Year
(From-To) / Board
Primary(1-5)
Middle(6-8)
Matric(9-10)
F.ScPart-I(11)
F.ScPart-II(12)

Signature of EDO (Education)

With official stamp

Verified by the DCO of concerned District/FR or PA of Agency

DCO/PA: ______

With official stamp

KHYBER MEDICAL UNIVERSITY

STUDY COMPLETION BOND

Tobefilledbythe studentonStamppaperof Rs.30/-anddulyattestedbyFirstClassMagistrate/PoliticalAgent/OathCommissionerinthepresenceof twowitnesses.

I______S/O/D/O/Wof ______hereby solemnlyaffirmsthatIwillcompletethewholetenureof mystudyat KMU-IMS/IDS, KOHAT.Iwillnotseekadmissionin anyothermedicalinstitutenorwill Ireappearin ETEAtestatanystageof mystudy tenure.

Ifurtheragreetotheprovisionthatmyoriginaldocumentsshallremainin safecustodywithKMU-IMS/IDS, KOHATtillthe completionofmystudytenureandIshallnotdemandforitsreturnbacktomebeforethecompletionof mystudytenure.

Incase,Iintendtocancelmyadmissionat anystageofmystudyperiod,aftertheclosureof admission,Ishallbeliableto a penaltyof Rs.400,000/-(FourHundredThousand)forwastinga preciousseat.Theoriginal documentwillbereturnedtomeonlyafterthepaymentof theduepenalty.

Signatureof Student: ______

Nameof Student: ______

Father'sNameof thestudent: ______

CNIC#ofthestudent: ______

PresentPostalAddress: ______

______

PermanentAddress:______

______

Witness-1 Witness-2

Signature: ______Signature: ______

Name: ______Name: ______

CNICNo: ______CNICNo: ______

Father’sName: ______Father’sName:______

Present/PostalAddress:______Present/PostalAddress: ______

______

Permanent PostalAddress:______Permanent Address: ______

______

Signatureand Stampof

FirstClassMagistrate/PoliticalAgent/OathCommissioner: ______

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