ANNEXURE – I

All candidates should furnish a certificate from the employer under whom the

candidate is presently working in the prescribed form as the situation may be.

• FORM A – Endorsement by the head of the institute under whom the candidate

is presently working/studying with, in case of candidates seeking admission

under service quota.

• FORM B – Endorsement by the head of the institute under whom the candidate

is presently working with, in case general candidates.

• FORM C -- Declaration by candidate in case the candidate is not currently

employed

• FORM D – Course completion certificate to be produced by candidates who have

not completed their MD/MS/DNB course

• FORM E – Endorsement by the head of the institute under whom the candidate is

presently working/has worked with, in case of candidates seeking marks as per

Annexure II, Part III (work experience in Surgical/Medical/Pediatric Oncology)

FORM A NO OBJECTION CERTIFICATE

(ON THE LETTERHEAD OF THE INSTITUTE)

Dr.____________________________________________________________________

is working as ____________________________________________________ with

effect from _____________________________________. He / she is a

permanent/temporary employee of

the__________________________________________________________

_______________________________________________________________________.

The information furnished by the candidate in his application form is correct. I have no

objection to his / her seeking admission to MCh/DM course at the Regional Cancer

Centre, Thiruvananthapuram. He / She will be relieved from his post for a period of three

years for undergoing the course if selected and admitted to the course at RCC and his/her

salary/stipend will be paid by his employer during the three year period of course.

Name of the Employer: ____________________________________________________

Name of the Institute: ____________________________________________________

Place: Signature of the Employer

Date: Seal

FORM B NO OBJECTION CERTIFICATE

(ON THE LETTERHEAD OF THE INSTITUTE)

Dr._____________________________________________________________________

is working as ____________________________________________________ with

effect from _____________________________________. He / she is a

permanent/temporary employee of the

________________________________________________________

_____________________________________________________. The information

furnished by the candidate in his application form is correct. I have no objection to his /

her seeking admission to MCh/DM course at the Regional Cancer Centre

Thiruvananthapuram. He / She will be relieved from his post for a period of three years

for undergoing the course if selected and admitted to the course at RCC.

Name of the Employer: ____________________________________________________

Name of the Institute: ____________________________________________________

Place: Signature of the Employer

Date: Seal

FORM C

DECLARATION BY THE CANDIDATE

I declare that all the information furnished in the application form by me is correct and

true. I declare that I am not currently employed/studying in any institution/hospital in

either Government/public/private sector and incase of my selection for the course there

would not be any issue of my getting relieved from any post held by me.

Place: Signature of the candidate

Date: Name of candidate

FORM D COURSE COMPLETION CERTIFICATE

(On the letterhead of the institute/department)

This is to certify that Dr.__________________________________________________________

is undergoing his postgraduate course (MD/MS/DNB) in the Department of

____________________________________________________________________________ at

______________________________________________________________________________

______________________________________________________________________________

and is likely to complete his course by______________________________(DD/MM/YYYY)

Name of the Institute: ___________________________________________________________

Place: Signature of the principal

Date: Seal

FORM E EXPERIENCE CERTIFICATE

(On the letterhead of the institute/department)

This is to certify that Dr.__________________________________________________________

is working/has worked in the Department of Surgical/Medical/Pediatric Oncology at the

______________________________________________________________________________

_______________________________________________________as_____________________

______________________________________________________________________________

_____________________________________________for a continuous period with effect from

___________________________________to

_________________________________________

I have no objection in his / her seeking admission to the MCh/DM course at the Regional Cancer

Centre, Thiruvananthapuram. His/Her conduct during the period mentioned above has

been_________________________________________________________________________.

Name of the Employer: __________________________________________________________

Name of the Institute: ___________________________________________________________

Place: Signature of the Employer

Date: Seal

ANNEXURE – II MARKS PROCESS

Part I - THEORY - 100 marks

MCQ paper containing 100 Questions (1 mark for correct answer, minus half mark for wrong

answer). No marks will be awarded for unanswered questions or multiple responses. Candidates

will be short listed purely on the basis of theory marks. The number of candidates short listed

will be four times the number of seats available.

Part II - INTERVIEW (VIVA) - 20 marks

Candidates will be assessed about clinical procedures, skills, aptitude, commonly practiced

protocols, current evidence and recent advances in the speciality.

Part III - PRIOR ACADEMIC RECORDS - 10 marks

Prior academic performance /experience will be awarded credits subject to a maximum of 10

marks.

1. Publications in Indexed Medical Journals only (Please submit Xerox copy of publication)

One mark/ publication subject to a maximum of 05 marks

2. Work experience in Surgical/Medical/Pediatric Oncology (Maximum 05 marks)

Six months to less than one year – 01 mark

One year or more – 02 mark/ year

Only continuous experience in an exclusive Surgical/Medical/Pediatric Oncology department

will be considered for this purpose. No marks will be given for experience of less than 6 months

and for discontinuous period of experience. Candidate needs to produce a certificate to prove the

experience in Surgical/Medical/Pediatric Oncology Department as in the Form E of

ANNEXURE I.

ANNEXURE III

AUTHORIZATION LETTER Submitted by an Authorized representative

[See Clause VII (g) of the prospectus]

I, ______________________________________________________(name of candidate)son/daughter of Shri./Smt. _________________________ having Roll No. _______________ in the RCC, Thiruvananthapuram Post graduate Superspeciality Entrance Examination 2016, with Rank _____________, do hereby authorize Shri/Smt __________________________________________________________________________________________________________________________________________________________________________________________

____(name and address of the person being authorized) to represent me to report at the allotment venue for admission to Surgical/Medical/Pediatric Oncology course in 2016. The signature of the person authorized is attested below by a Gazetted Officer.

Signature of the Candidate:

Name of the Candidate: ___________________________________________________

Address: ______________________________________________________________

_____________________________________________________________

_____________________________________________________________

Name and Designation of the Gazetted Officer

Office Seal

Signature of the Authorized Representative:

ATTESTED:

SIGANTURE OF THE CANDIDATE

Candidate to sign over the photograph

UNDERTAKING I, undertake that the decision taken if any, by my authorized representative at the allotment venue shall be binding on me and I shall not have any claim whatsoever, other than the decision taken by my authorized representative on my behalf. Place : Date :

Signature of the Candidate Note: An authorized representative attending counseling, 2016 must bring a photocopy also of the filled up form. The same will be returned to the representative with the seal of the Director RCC. This copy of the filled up form having the seal of the Director RCC can be used in lieu of authorization letter during subsequent appearances.

ANNEXURE IV Format for appeal regarding mistakes in questions / answers

Use separate sheets for each question/answer appeal

Incomplete appeals will be rejected

Name of the candidate

Admit Card Number

Speciality applied for

Question number

Error as noticed by the candidate

Correction as suggested by candidate

Reference for the correction

suggested (Name of the text, edition,

volume, chapter, page, line)