ADMISSION BROCHURE.

PG : 2017-18 Veer Surendra Sai Institute of Medical Sciences & Research

Ayurvihar, Burla, Sambalpur, Odisha, India-768017 www.vimsar.ac.in, vssmcburlaorissa@gmail.com

AIQ SQ

Name of Candidate_________________________________________________________________________

Rank No______________Roll/ Confirmation No_____________Application No/ Testing ID______________

Date of Birth________________________Subject________________________________________________

Reservation Category: GEN SC ST OBC PH GC ES

Phase Institute of Admission

Date of Admission

Date of Relieve

Date of Resignation

Round-I

Round-II

Final Status

PAGE LAY OUT

1. Stepwise Admission Procedure 01

2. Institute Profile Back cover

3. Student’s Bio Data 02

4. Document Submission Sheet 03

5. Document Custodian Certificate 04

6. Undertaking towards Up Gradation/ Undertakings/ Resignation

05

7. Medical Fitness Certificate 06-07

8. Scrutiny Sheet 08

9. Relieve Order 09-10

1. Report at Education section to PG clerk Mr. S.R. Maharana.

2. Put Full signature & Roll No. in the admission attendance sheet .

3. Collect Institute Admission Brochure.

4. Deposit the documents as per list in page…..of brochure.

5. Fill up the relevant pages of Brochure including the cover page.

6. Deposit all necessary documents.

7. Proceed to OPD block of Hospital for Medical Fitness test.

8. Go to Document Verification Desk.

9. Deposit the Admission fees as cash/DD/Net banking if admission is allowed.

10. Submit a copy of the Receipt of fees deposited at Admission Desk.

11. Report for online admission at Computer Desk.

12. Give option for second round in the format of the brochure.

13. Sign in the admission Register.

14. Receive in original the following papers from the office before leaving:

a. Admission letter duly sign by the college authorities

b. Original document retention certificate.

c. Original fee receipt.

15. While resigning or being relieved do ask for return of the retained original documents from

the college by surrendering the original document retention certificate.

16. Admission process may take more than one day.

000

Stepwise Admission Procedure

Pg-01

1. Name of the Student:

2. Date of Birth :

3. Father’s Name :

4. Mother’s Name :

5. Caste (Sub-caste)/Tribe:

6. Occupation of Father:

7. Annual Income of father as per record:

8. Permanent Address:

Vill/Town………………………………………… P.S……………………………………………….…

P.O………………………………………………… Dist……………………………….…………….….

State………………………………………………. Pin…………………………………….……….….

9. Present Communication Address:

Vill/Town…………………………………………… P.S…………………………………………………

P.O………………………………………………… Dist…………………………………………….….

State……………………………………………… Pin…………………………………………….…..

10. Telephone No. of Student Land Line No………………………………………………………

Cell Phone No………………………………………………………

Mail Id……………………………………………………………….

11. Telephone No. of Father/Legal Guardian: Land Line No…………………………………………

Cell Phone No……………………………………………………….

Mail Id……………………………………………………………..….

12. MBBS Details: Year of Passing:……………………………………………..……

College…………………………………………………………….…

University……………………………………………………………..

State……………………………………………………………….….

13. Accounts details for fees refund: Saving Bank Accounts Number……………………………

Name of the Bank…………………………………………………

Name of Branch………………………. IFSC Code………………

Signature of Student…………………………………………

Date: …………………………………………………..

Recent passport

Color Photograph

(Only staple don’t

paste)

Student Biodata

Pg-02

[Tick at appropriate box]

document yes no

1. Admit Card

2. Rank Letter

3. Provisional Allotment Letter

4. HSC Certificate for DOB

5. MBBS Certificate

6. Mark Sheet/1st/2nd/3rd/final MB

7. Internship Certificate

8. MCI registration Certificate

9. Bond

10. TC/CLC

11. Conduct Certificate

12. Caste certificate (ST/SC/OBC)

13. PH Certificate

14. Any Other

I am submitting herewith the documents as listed above in Original (numbering……….) along with photocopy of each for verification and institutional custody for admission in to PG course during the year 2017-18 at Veer Surendra Sai Institute of Medical Sciences & Research, Burla:

I undertake that if, on any day now on, I am found to have submitted any wrong information with regards to the documents and certificates produced by me at the time of admission then my admission to the course stand cancelled and I shall be entitled to legal action as deemed proper by rule

Signature of the Candidate

Roll Number-……………………………….

Name…………………………………………….

Custodian Certificate:- Certified that the original documents (as enlisted above) numbering ……… submitted by the candidate

Dr…………………………………………. during admission is kept in the custody of this office till he/she fulfills

the bond requirments or the candidate gets relieved or resigns from the course.

Signature of PG Clerk Signature of Bursar

Document Submission Sheet

Fitness Certificate [pg-1/2]

Pg-03

[Tick at appropriate box]

document yes no

1. Admit Card

2. Rank Letter

3. Provisional Allotment Letter

4. HSC Certificate for DOB

5. MBBS Certificate

6. Mark Sheet/1st/2nd/3rd/final MB

7. Internship Certificate

8. MCI registration Certificate

9. Bond

10. TC/CLC

11. Conduct Certificate

12. Caste certificate (ST/SC/OBC)

13. PH Certificate

14. Any Other

I am submitting herewith the documents as listed above in Original(numbering….) along with photocopy of each for verification and institutional custody for admission in to PG course during the year 2017-18 at Veer Surendra Sai Institute of Medical Sciences & Research, Burla:

I undertake that if, on any day now on, I am found to have submitted any wrong information with regards to the documents and certificates produced by me at the time of admission then my admission to the course stand cancelled and I shall be entitled to legal action as deemed proper by rule

Signature of the Candidate

Roll Number-……………………………….

Name…………………………………………….

Custodian Certificate:-

Certified that the original documents (as enlisted above) numbering………………submitted by the candidate

Dr…………………………………………. during admission is kept in the custody of this office till he/she fulfills

the bond requirements or the candidate gets relieved or resigns from the course.

Signature of PG Clerk Signature of Bursar

Document Custodian Certificate

Pg-04

I do express my willingness to participate/ not to participate in SECOND ROUND of AIPG counseling for up

gradation.

Signature in Full

Name………………………………………………………………….. NEET-PG Roll Number………………………

Place……………………………………………………..…………. Date………………………………………………

I do hereby undertake to produce the following documents within a time of_______days failing which my

conditional admission into the course will stand cancelled and I shall forfeit my claim for admission into the

college.

1……………………………………………………………………………………………………………………………

2………………………………………………..…………………………………………………………………………

3………………………………………………..…………………………………………………………………………

Signature in Full

Name………………………………………………………………….. NEET-PG Roll………………………

Place……………………………………………………..…………. Date………………………………………………

I do hereby resign from PG Seat subject………………………………………………………..

College……………………………. During counseling period knowing very well that I will have no claim over the

seat in future and I will be out of PG counseling process 2017-18.

Date…………….. Signature in full

Place……………. Name…………………………………………..

Roll No………………………………………….

WILLINGNESS TOWARDS UPGRADATION DURING COUNSELING

BLOCKADE

UNDERTAKING TOWARDS TIME BOUND SUBMISSION OF DEFICIENT DOCUMENTS

BLOCKADE

LETTER OF RESIGNATION

Undertakings

Pg-05

Certified that on this day dated …………………………………. We have examined

Mr./Ms Dr.…………………………………………………………… Rank/Merit No……………..……….. For

physical Fitness for Medical Studies. The findings are detailed below.

1. Name ………………………………………………………………………………………………………….:

2. Father’s Name………………………………………………………………………………………………...

3. Age…………………. 4. Sex………………… 5. Weight…………… 6.. Height………………….

7. Personal Marks of identification:

i………………………………………………………………………………………………………………….

ii…………………………………………………………………………………………………………………

8. Vitals:…………………………………………………………………………………………………………..

9. General Examination:………………………………………………………………………………….…..

10. Cardiovascular System: …………………………………………………………………………………..

11. Respiratory System:………………………………………………………………………………………..

12. Central Nervous System :………………………………………………………………………………...

12. Gastro-intestinal System:………………………………………………………………………………….

13. Vision:…………………………………………………………………………………………………………..

14. Hearing: …………………………………………………………………………………………………….

15. Genitourinary System :………………………………….…………………………………………………

16. Locomotor System:………………………………………………………………………………………..

17. Any Other Disability:……………………………………………………………………………………….

-PTO-

Medical Fitness Certificate [pg-1/2]

Pg-06

18. The Candidate is medically fit/ unfit for admission into MD/MS course.

Date- Sig. of Consultant on Duty, Medicine OPD, VIMSAR, Burla Seal- Name- Designation-

19. The Candidate is medically fit/ unfit for admission into MD/MS course.

Date- Sig. of Consultant on Duty, General Surgery OPD, VIMSAR, Burla Seal- Name- Designation-

20. The Candidate is medically fit/ unfit for admission into MD/MS course.

Date- Sig. of Consultant on Duty, O&G OPD, VIMSAR, Burla Seal- Name- Designation-

21.The Candidate is medically fit/ unfit for admission into MD/MS course.

Date- Sig. of Consultant on Duty, EYE OPD, VIMSAR, Burla Seal- Name- Designation-

22. The Candidate is medically fit/ unfit for admission into MD/MS course.

Date- Sig. of Consultant on Duty, ENT OPD, VIMSAR, Burla Seal- Name- Designation-

23. The Candidate is medically fit/ unfit for admission into MD/MS course.

Date- Sig. of Consultant on Duty, Orthopedics OPD, V IMSAR, Burla Seal- Name- Designation-

General Medicine

General Surgery

O&G (only female)

EYE

ENT

Orthopedics

Medical Fitness Certificate [pg-2/2]

Pg-07

Name……………………………………………………………………………………………………………………

Roll No……………………………………………Application No……………………………………………………..

D.O.B. (DD/MM/YY)………/………./………..

Category: GEN ST SC OBC PH ES GC S.No Document Submitted (original & self-signed photocopy) Verified and Authenticated

1. ID Proof(Original to be returned after verification) Yes No

2. NEET Admit Card (Roll No ______________________________) Yes No

3. NEET Rank Letter (NEET Common Rank________________) Yes No

4. Online generated Self-declaration Slip [only for AP-TL-JK natives ]

[ Verified online- yes/no]

Yes No

5. Provisional Allotment Letter Yes No

6. Relieving Letter (applicable for second round) Yes No

7. MBBS Degree Certificate Yes No

8.. MBBS Mark Sheet [1st,2nd, 3rd & Final] Yes No

9. Internship Certificate(31st March 2017) Yes No

10. Registration Certificate by MCI/State Council(Permanent /Provisional) Yes No

11. Birth Certificate Yes No

12. Transfer Certificate/College Leaving Certificate Yes No

11. Conduct Certificate Yes No

12. Submission of Bond(ME-II-IXM/88/2008, Order No. 3418/H date 03.02.2017) Yes No

13. Two passport size photographs Yes No

14. Reservation Certificate(ST/SC/OBC/PH/GC/ES) Mention:________

Issued by native state [OBC status verified from Central OBC list online -yes/no]

Yes No

15. Declaration to participate in 2nd round counseling Yes No

16. Medical Fitness certificate by the Institute Yes No

17. Receipt of admission fees for Rs.40,300/- [Cash receipt/ DD/e-transfer slip]

DD No./Fee Receipt Number /Online transaction slip no-…………………………..

Dated _____________________

Yes No

18. Other documents (mention)__________________________________

[Eligible for Admission Not Eligible for Admission ] reason thereof.

Signature of Bursar Signature of Scrutiny Officer

Allowed Admission:

Dean & Principal, VIMSAR.

Scrutiny Sheet

Pg-08

OFFICE COPY

Dr…………………………………………………………………………..……..

Roll No…………….……………………………………………………………...

Rank No…………………………………………….. Admitted in PG course in

the …………………………………………………………...…. Department in

Round No. …………………………..………………………… is hereby

relieved on dated…………………………………….. from this Institute due

to reallocation of seats/resignation.

Memo No____________/MC. Dean & Principal

Dated_________2017 VIMSAR,Burla

RELIEVE ORDER OFFICE COPY

Pg-09

Dr…………………………………………………………………………..……..

Roll No…………….……………………………………………………………...

Rank No…………………………………………….. Admitted in PG course in

the …………………………………………………………...…. Department in

Round No. …………………………..………………………… is hereby

relieved on dated…………………………………….. from this Institute due

to reallocation of seats/resignation.

Memo No__________/MC. Dean & Principal

Dated_________2017 VIMSAR

RELIEVE ORDER STUDENT’S COPY

Pg-10

Institute Profile

College Code : OR03

College : VSS Institute Of Medical Sciences & Research [formerly VSS Medical College]

State : Odisha

Name of Institute : VSS Institute Of Medical Sciences & Research

Address of Institute : At/Po-Ayurvihar, Burla, Dist-Sambalpur,Odisha-768017.

Office dial Phone: 0663-2430768 Fax: 0663-2430767

Affiliating University : Sambalpur University, Jyotivihar,Burla,Sambalpur.

Session Start Date : May 01-2017

Admission Amount to be paid (₹) : 40300.00

Annual Fee for AIQ Candidates (₹) : 26600.00 per year for next two years

Stipend 1st Year||2nd Year|| 3rd Year (₹): [All seats are Stipendiary]

39950.00 || 41899.00 || 43848.00

Hostel facility : For Male & Female both

Monthly hostel dues (₹) : 1000.00

Bond conditions : Bond has to be submitted at the time of admission towards post-pg mandatory two year service and penalty on discontinuation of study before completion [as detailed vide Govt. of Odisha Health & Family Welfare Department Resolution No.3418 dated 03-02-2017]

The amount of fee to be reimbursed in case of reallocation or resignation during

the counseling process (₹) :

36000.00

Time period of reimbursement : 90 days after leaving

Institute website : www.vimsar.ac.in

Institute Email Id: vssmcburlaorissa@gmail.com

Key contact: Mr.Shibaram Maharana, PG Education Clerk Cell-919437558108

Other Information : Available in institute website.