pg medical prospectus application form-2010

OFFICE OF THE PRINCIPAL, S.C.B. MEDICAL COLLEGE, CUTTACK ……….

No.7893 Dated, Cuttack the 14.12. 2009. From: Prof.(Dr.) P.K. Chinara,

Principal, S.C.B. M.C, Cuttack. & Convenor, P.G. Medical Selection Committee-2010.

To

The Head, State Portal Group, Information & Technology Centre, Department of Information & Technology, Orissa.

Bhubaneswar. Sub: Post-Graduate (Medical) Prospectus & Application Form- 2010 Sir, I am to transmit the details of Prospectus & Application Form of P.G. (Medical) 2010 through E-Mail and to request you to please up load the same in the Govt. Website i.e www.orissa.gov.in for information of the prospective candidates. This may be displayed from 15.12.2009 to 05.01.2010, 5 P.M in the Website. Please treat this as most urgent.

Yours faithfully, Sd/


Memo. No.7894 Dt.14.12.2009. Copy forwarded to the D.M.E.T., Orissa, Bhubaneswar for information and necessary action. Sd/-


Memo. No.7895 Dt.14.12.2009. Copy forwarded to the Addl. Secretary to Govt. Health & F.W. Department for information and necessary action. Sd/-


Memo. No.7896 Dt.14.12.2009. Copy forwarded to the Addl. Secretary to Govt. I.T Department for information and necessary action. Sd/-


POST-GRADUATE (MEDICAL) SELECTION – 2010, ORISSA

PROSPECTUS FOR

SELECTION OF CANDIDATES FOR

POST-GRADUATE (MEDICAL) COURSES IN THE GOVERNMENT MEDICAL COLLEGES

OF ORISSA

APPROVED BY THE

DEPARTMENT OF HEALTH & FAMILY WELFARE, GOVERNMENT OF ORISSA

(Vide Letter No -27881 / H & F.W. Dt. 17.12.08)

Along with the application form candidate is to enclose A/c payee Bank Draft of Rs.1000/- (Rupees One thousand only) (in original) drawn in

favour of “Convenor, P.G. (Medical) Selection Committee-2010” Payable at State Bank of India, MCC Branch, Cuttack (Code No. 5760)

IMPORTANT INFORMATION

1. The Prospectus & Application Forms will be available in Govt. Website i.e.

www.orissa.gov.in (Click views for all advertisement). No printed Prospectus &

Application Forms will be sold in the counter of the Medical College.

2. Last date &Hour of receipt of Application Forms ………. 05-01-2010, by 5 P.M

3. Date of Entrance Examination:……………………………. 24.01.2010

4. Dates of Counseling :…………………………………………09-04-2010 & 10-04-2010

5. Last date up to which students can be admitted ……. 31.05.2010 against vacancies arising due to any reasons.

PROGRAMME OF COUNSELLING

Day Morning Afternoon

First (09-04-2010)

Reserved Categories (Both In-service & Direct)

Scheduled Tribe (S.T.)

Scheduled Caste (S.C.)

Physically Handicapped (P.H.)

Children of Service / Ex-

service personnel (Defence)

General Candidates (in-service)

Second (10-04-2010) General Candidates (Direct)

General Candidates

(Direct) – Continued

PROSPECTUS FOR SELECTION OF CANDIDATES FOR POST-GRADUATE COURSES IN THE GOVERNMENT MEDICAL COLLEGES OF ORISSA – 2010

(PLEASE READ THESE INFORMATION CAREFULLY)

(INCOMPLETE, ILLEGIBLE AND INCORRECT APPLICATIONS WILL BE SUMMARILY REJECTED)

1. GENERAL INFORMATION : 1.1. Selection of candidates for Post-Graduate (Medical Courses in three

Government Medical Colleges of Orissa affiliated to three different Universities of Orissa shall be conducted by the P.G. (Medical) Selection Committee until otherwise directed by the Government.

1.2. The P.G. (Medical) Selection Committee – 2010 shall consist of :

(i) Director, Medical Education & Training, Orissa - Chairman

(ii) Principal, S.C.B. Medical College, Cuttack - Convenor

(iii) Principal, M.K.C.G. Medical College, Berhampur - Member

(iv) Principal, V.S.S Medical College, Burla - Member

(v) Director, AHRCC, Cuttack - Member

(Vide Govt. letter No.27881/ Dt. 17.12.08 of the Health & F.W .Department)

1.3. Applications in the prescribed form are invited for selection of candidates for the P.G. (Medical) Courses available at S.C.B. Medical College, Cuttack (Utkal University), V.S.S. Medical College, Burla (Sambalpur University) and M.K.C.G. Medical College, Berhampur (Berhampur University) for the year 2010.

2. COMMENCEMENT OF SESSION : The admission will be made once a year. The academic session commences from 2nd May 2010, unless otherwise notified. The applicants under In-service category are required to fulfill the eligibility criteria by 31st December, 2009 and the applicants under Direct Category are required to fulfill the eligibility criteria by 31st March, 2010.

3. DURATION OF THE COURSE : 3.1. The Post-Graduate (Medical) courses usually are of 3 years duration from the

date of commencement of the course i.e. 2nd May subject to joining of the candidate in the course.

3.2. Candidates having recognized P.G. Diploma shall be exempted one year from the total duration of P.G. (Medical) Course provided they undergo P.G. (Medical) Course in the same subject.

3.3. All admissions to P.G. (Medical) Courses are subject to approval of the concerned Universities and Medical Council of India.

4. AVAILABILITY OF SEATS : Seats available for P.G. (Medical) Courses in the three Government Medical Colleges of Orissa: (Details in Appendix – 1(A))

Reserved Category Category M.D./M.S.

Course

General ST (12%) SC (8%) PH Defence (3%)

Total

In-service 47 8 5 2 - Nil - 62

Direct 45 7 5 2 2 61

Total 92 15 10 4 2 123 Note: All above Reservations shall apply to the natives / permanent residents of Orissa only.

5. ELIGIBILITY CRITERIA OF CANDIDATES : The Candidate Must have passed M.B.B.S. Degree Examination from an Institution recognized by Medical Council of India and must be:

5.1. A permanent resident of Orissa (Certificate of Permanent Residence of Orissa from a Revenue Officer not below the rank of Tahasildar of the area concerned (in Form No.III, in Appendix III - B)).

OR 5.2. The Son/Daughter/Spouse of any one of the following category …

5.2.1. Employees of Government of Orissa.

5.2.2. All India Services belonging to Orissa Cadre serving within or outside Orissa.

5.2.3. Public Sector undertaking of either State of Orissa or Govt. of India located in Orissa.

5.2.4. Defence Services personnel stationed in Orissa.

OR 5.3. Belonging to other State(s) and must have completed their M.B.B.S. studies in

any one of the three Government Medical Colleges of the State of Orissa. (Note: The applicant must submit particulars of his/her undergraduate medical career as per Appendix-V)

5.4 Must have completed one year of compulsory Rotatory Internship/ Houseman ship by 31st March 2010 (Only for Direct Candidate).

5.5 Must have permanently registered himself/herself with State/Central Council of Medical Registration.

5.6 Candidates who have completed P.G. (Medical) Course in any subject shall not be eligible to apply for P.G. (Medical) course.

5.7 Candidates must not have taken admission in P.G. Medical Course in any of the three Medical Colleges of Orissa, and have not joined/discontinued after joining or undergoing P.G. course within last 3(three) years.

6 CATEGORY OF CANDIDATES : 6.1 A Direct Candidate is one who at the time of application:

6.1.1 Holds a Degree from a Medical College recognized by the M.C.I. and has completed or would complete one year of Compulsory Rotatory Housemanship / Internship in a Hospital recognized by Medical Council of India for the purpose on or before 31st March 2010

6.1.2 Is serving in Defence Service but posted in Orissa. He / She must have worked for minimum 5 years in Orissa by 31st December 2009. Only his/her Son/daughter/ spouse will be eligible to apply (Refer 5.2.4)

6.1.3 Is in the employment of Govt. of India & at the time of application posted in Orissa in a public sector undertaking of Govt. of India located in Orissa & has completed five years of service in Orissa by 31st December, 2009,. The employer has to sponsor the candidates for entire period of course including Post-P.G. Mandatory Service and agreed to bear the cost of the emoluments during that period. Such payment will not be the responsibility of Govt. of Orissa.

6.2 An In-service candidate is one who at the time of application :

6.2.1 Is in the employment in Government of Orissa and has completed 5 years of service in Orissa which includes all categories of employment like contractual / temporary / adhoc/ regular by 31st December, 2009.

Note: In-service Medical Officers are advised to submit their applications along with the required documents directly to the Convenor, P.G. (Medical) Selection Committee – 2010, under intimation to their Employer.

6.3 Seats reserved for S.T. and S.C. candidates are to be filed up by the applicants belonging to the community as per the Orissa Caste Certificate (for S.C. and S.T.) Rules – 1980 and as amended from time to time by Government of Orissa. (In Form No. V, in Appendix III - C).

6.4 Seats reserved for Children or Spouse of Service / Ex-service personnel (Defence) are to be filled up by such candidates under the Direct category only. (In Appendix III - B).

6.5 Seats reserved for physically handicapped will be filled up by the candidate having locomotory disorders of lower limbs between 50% to 70%. Provided that incase any seat in this 3% Quota remain unfilled on account of unavailability of candidates with locomotory disability of lower limbs between 50% to 70% then any such unfilled seat in this 3% quota shall be filled up by persons with locomotory disability of lower limbs between 40% to 50% - before they are included in the annual sanctioned seats for General Category candidates (vide Notification No-MCI-18(1)/2008-Med./54470 dt. 25.03.2009)

Note: Schedules Caste/Scheduled Tribe persons who have migrated from their State of Origin to some other State for the purpose of seeking education, employment etc. will be deemed to be scheduled Caste/Tribe of the State of their Origin and will get privilege from the State of origin and not from the State to which they have migrated. (Vide Govt. of India Letter No.BC/16014/1/82-SC & BCD/Dated: 22nd February 1985).

7. DOCUMENT TO BE SUBMITTED ALONG WITH APPLICATION : An applicant for P.G. (Medical) admission must submit self attested photocopies of following documents along with his/her application duly signed by himself / herself in full.

7.1 Certificate of Board of Secondary Education / Matriculation / 10th Class Pass Certificate or equivalent in support of date of birth of the candidate.

7.2 M.B.B.S. Degree or Provisional MBBS Pass Certificate issued by the concerned University.

7.3 Completion Certificate of Compulsory Rotatory Internship / Housemanship, issued by the Principal / Superintendent of the Medical College / Hospital concerned, showing that he / she has completed/ would complete the same by 31st March, 2009.

7.4 Permanent Medical Registration Certificate State / Central Medical Council. 7.5 Adequate postage stamps to be affixed in the space provided for in the

Application Form. 7.6 Three attested recent colour / black and white photographs of size 40x50mm

should be attached to the space provided in the Application Form, Admit Card and Attendance Card (in addition, One recent Colour photograph of size 40x50 mm is to be pasted on Medical Certificate (Appendix-VI).

7.7 Certificate from competent authorities in support of eligibility criteria claimed under Clause No.5 (Necessary documents may be furnished in support of the claim made by the applicant in Appendix III-A to D as applicable).

7.8 In-service candidates who have rendered the required length of service as per Clause No. 6.2.1 must submit a certificate from the concerned C.D.M.O. (s) or appropriate authorities in support of his / her claim stating therein chronologically the place of posting, duration of service including Contractual, Temporary, Adhoc and Regular postings, the respective places and the Block and the District to which the place belongs.

7.9 Leave period exceeding 30 (thirty) days at a stretch shall not be counted towards the length of service.

7.10 Tribe / Caste Certificate (for ST/SC Candidates) from a Revenue Officer not below the rank of Tahasildar of the concerned area (in the Form No.V in Appendix III-C).

7.11 In case of candidate claiming to be Physically Handicapped (PH), Certificate issued by Panchayat Raj Department, Government of Orissa / District Social Welfare Officer authorized by Government, Women and Child Welfare Department, Govt. of Orissa.

7.12 Certificate in support of children or spouse of service personnel / ex-service personnel(Appendix III-D)

7.13 Candidates claiming eligibility under Clause No.6.1.2 & 6.1.3 are required to furnish “Sponsoring Letter” (in original) in the prescribed proforma in Appendix-IV.

7.14 Xerox copy of the Bank Draft of Rs.1000 /- drawn in favour of “Convenor, P.G. (Medical) Selection Committee – 2010” payable at State Bank of India, Medical College Campus Branch, Cuttack (Code No-5760)

Note: Mark Sheets of the Examinations passed are not required. Appendix forms must be detached from the prospectus and used along with the Application Form.

8. PROCEDURE FOR SUBMISSION OF APPLICATION: 8.1 Complete application in prescribed form along with relevant documents is to be

sent to “Convenor, P.G. (Medical) Selection Committee-2010, & Principal, S.C.B. Medical College, Cuttack, Orissa, Pin – 753007 by Registered Post / Speed Post only. Application received by any other mode shall be rejected.

8.2 All relevant documents should be tagged (not stapled) together to the Application Form securely and serially.

8.3 Not more than one application should be sent in one envelope. In case, more than one application is received in one envelope, all shall be rejected.

8.4 Application received incomplete in any respect or after the prescribed last date or addressed to any agency other than the Convenor shall be rejected.

8.5 Request for any alteration, addition, correction or modification etc. of entries in the application already submitted will not be entertained.

9 METHOD OF SELECTION OF CANDIDATES : 9.1 Candidates belonging to both direct and in-service category shall be selected

through an Entrance Examination. The Entrance Examination shall be conducted at the center as to be decided by the Selection Committee. No. TA/DA will be paid for attending the said Examination.

9.2 There shall be one paper of three and half hours duration containing 300 multiple- choice questions in English divided into two parts. Part-I shall consist of Non-clinical and Para-clinical subjects and Part-II shall consist of Clinical subjects. The subject wise number of questions is given in Appendix-II

9.3 The questions in both parts shall be of MBBS standard and shall cover all the subjects of MBBS Course.

9.4 There shall be four different choices for each question. Candidates should choose the most appropriate choice amongst them. All questions will be of objective type (MCQ).

10 CONDUCT OF EXAMINATION : 10.1 The Entrance Examination will be conducted at centers as would be decided by

the PG (Medical) Selection Committee – 2010 on the date and time as will be indicated in the Admit Card.

10.2 Change of Examination Centre is not permissible. 10.3 A candidate, who does not possess the Admit Card issued by the Convenor,

shall not be allowed to the Examination Hall under any circumstances. 10.4 Candidates are to occupy their seats 15 minutes before the commencement of

the Examination. 10.5 No candidate shall be allowed to the Examination Hall after commencement of

the Examination. Similarly, no candidate will be allowed to leave the Examination Hall before the examination is over. Temporary absence by the candidate from the Examination Hall for any reason is strictly prohibited.

10.6 No candidate shall be allowed to carry any textual material printed or written, except Admit Card (without envelope) into the Hall.

10.7 Shifting or change of seats shall be counted as an act of misconduct and candidate shall forfeit the right to continue writing further in the Examination.

10.8 The candidate shall maintain silence and attend to his / her paper only. Any one causing disturbance in the Examination Hall shall forfeit the right to continue writing further in the Examination.

10.9 Separate sealed packets of Question and Answer Booklets (Q & A Booklet) shall be opened and given to the candidates 5 minutes before the commencement of the Examination.

10.10 Candidates are to count the number of pages of the Q & A Booklets before opening the seal and report discrepancy, if any, to the Invigilator immediately for

replacement. Any complaint received after breaking the seal shall not be entertained.

10.11 Except putting the relevant entries in the Q & A Booklets as instructed, any additional writing, overwriting or any other marks in any form, disfiguring, folding, mutilating, soiling of the Q & A Booklet shall deemed to be an act of misconduct and shall be liable for cancellation of his / her Booklet.

10.12 In case the candidate finished answering earlier, he / she shall hand over the Q & A Booklet personally to the concerned invigilator of the hall and remain seated in the allotted seat till the examination is over.

10.13 It is the duty of the candidate to hand over personally his / her Q & A Booklet to the invigilator of the Examination Hall.

10.14 Any other instruction issued to the candidates in the Examination hall shall be treated as part of the Prospectus.

10.15 The decision of the Centre Superintendent shall be FINAL AND CONCLUSIVE regarding the conduct of candidate in the Examination Hall / Centre.

10.16 Carrying of Cellular Phones, Pagers, Calculators and any other electronic communication equipments are strictly prohibited.

10.17 The Model Question & Answer will be made available in the Website i.e. www.orissa.gov.in (Click views for all advertisement) on the next day of examination and accordingly the candidates will be given scope to file objection, if any, within 7(seven) days from the date of completion of the examination before the Chairman, who will take up the matter with a committee of experts and the decision of the committee would be final and binding on the part of the candidates. In case the objection is found true, the marks will be awarded accordingly at the time of evaluation of the answer sheets. After the stipulated period is over, no objection at any form will be entertained and liable to be rejected.

11 EVALUATION OF ANSWERS OF ENTRANCE EXAMINATION : 11.1 All questions will be single response objective type (Multiple Choice) only. The

marks will be awarded as follows :

Response Marks Correct 4 (Four)

Incorrect, more than one response, blank answer box. -1 (Minus One)

Answer box marked “X” or, cutting, erasing, overwriting or writing with pencil

0 (Zero)

ADDITIONAL WEIGHTAGE TO INSERVICE CANDIDATES:

11.2 Those in-service candidates who have completed minimum of three years service in KBK / Tribal / Backward areas & have qualified in the examination shall be awarded an additional weightage of 10% of the marks secured in the P.G.

Entrance Examination. Additional weightage of 5 % of the marks secured in the P.G. Entrance Examination shall be awarded to the rest of the in-service candidates who have qualified in the examination vide G.O. No. 36644/H dt. 12.12.2006. [in Form No Appendix – III (A)]

12 RESULTS : 12.1 Candidates securing 50% of total marks or more in case of general candidates

and 45% or more for persons with locomotory disabilities of lower limbs and 40% or more in case of SC/ST candidates in the Entrance Examination shall be eligible for selection and a merit list shall be prepared of all the eligible candidates.

12.2 The Merit lists shall be prepared and be published in the three Government Medical Colleges of Orissa and in the Office of Director of Medical Education & Training, Orissa. The merit list will also be available in the website i.e “www. orissa.gov.in”(Click views for all advertisement). The result of the individual candidate will not be intimated by post.

12.2.1 For eligible In-service candidates, after adding the credit marks as per clause 11.2 a “Provisional Common Merit List” shall be prepared with their rank number and a separate “ Provisional Merit List of each reserved categories” shall be prepared with their rank numbers.

12.2.2 For eligible direct candidates a “Provisional Common Merit List” with their rank numbers and separate “Provisional Merit List of Each Reserved Categories” with rank numbers shall be prepared.

12.3 While preparing merit lists, in case of two or more candidates securing equal marks the ranking shall be decided in order of preference as under :

12.3.1 Candidate securing higher marks in Part-II portion of Entrance Examination. 12.3.2 If this is equal, the elder, according to the date of birth furnished, will get

preference over the younger. 13 COUNSELLING FOR ALLOTMENT OF SUBJECT AND COLLEGE :

The candidate will be selected for admission by Counselling from the provisional Merit lists prepared.

13.1 The date, time and venue of Counselling shall be intimated to the eligible candidates in the Call / Intimation Letter to be sent by Regd. / Speed Post / Electronic Media / News Paper.

13.2 No TA / DA shall be paid for attending the Counselling. 13.3 Allotment of subject and College shall be made to the candidates on their

personal appearance at Counselling. 13.3.1 The candidate shall exercise his / her option in writing while choosing the Subject

and College. Option once exercised is FIRM and FINAL and can not be changed under any circumstances during that Counseling.

13.4 During Counseling the candidates must produce the original Admit Card along with the original documents (Copies of which they have already submitted with the Application Form).

13.5 If a candidate fails to turn-up for Counselling in the stipulated time, he / she shall be given an opportunity at the end of the scheduled Counselling of that day. He / She shall be allotted out of the unfilled available seats, if any, but he / she shall not have the right to claim a seat as per his / her position in the merit list.

13.6 If a candidate fails to turn-up on the scheduled date for Counselling, he / she would forfeit his / her claim.

13.7 If any seat falls vacant after the Counselling and admission including the vacant seats of All India Quota, the Selection Committee may go for second round of Counselling on another date subject to approval of the Govt., with in 31st May 2010 and beyond the cut off date i.e. 31st May no admission will be allowed.

14 SELECTION OF CANDIDATES : 14.1 Candidates shall be selected in order of merit from each category for admission

by Counselling and the order of Counselling shall be ST (in-service), SC (in service), ST (Direct), SC (Direct), PH (in-service), PH (Direct), Children for Service / Ex-service Personnel (Direct), General (in service), General (Direct) candidates.

14.2 Selection of ST / SC candidates :

14.2.1 In case of non-availability of eligible ST (in-service) candidates, the unfilled seats of their quota will be merged with SC (In-service) seats and the total seats thus derived shall be filled – up by SC (In-service) candidates.

14.2.2 The unfilled ST (in-service) and SC (in-service) seats if any shall be merged with the ST (Direct) and SC (Direct) seats respectively.

14.2.3 In case of non-availability of ST (Direct) candidates, the unfilled seats will be merged with SC (Direct) seats and the total seats thus derived shall be filled up by SC (Direct) candidates.

14.2.4 The seats of SC & ST (in-service and direct) candidates if left unfilled / vacant shall be filled up by General Category (in-service and direct) candidates respectively (in-service and direct).

14.3 Selection of Physically Handicapped Candidates :

14.3.1 If eligible physical handicapped candidates (in-service and direct) are not available, the seats shall be filled up by General (in-service) and General (Direct) candidates respectively.

14.4 Selection of Candidates under quota of Children / Spouse of Service / Ex-service personnel:

If eligible candidates under this category are not available, the seats shall be filled up by General (Direct) candidates.

14.5 Selection of General Candidates :

14.5.1 In case of non-availability of candidates against General (in-service) seats, the seats may be filled up by General (Direct) candidates.

14.5.2 Subject wise unfilled “All India Seats”, if any, will be distributed among In-service and Direct candidates on 50 : 50 basis as far as practicable, as per the category of the seats & keeping the provisions of the clause 14.2.4 in view.

15 ADMISSION AND JOINING : 15.1 Candidates will be admitted to the respective Colleges as per their choice

through their personal appearance at the Counselling center. Their declaration for choice of subject / college will be firm & final during that Counseling.

15.2 A candidate selected for admission shall have to deposit the following fees payable at the time of admission.

1. Admission fees (one time) Rs. 300.00

2. Consolidated tuition fees per term (Per annum) Rs. 6,000.00

3. Library fees (per annum) Rs. 200.00

4. Journal fees (per annum) Rs. 1,000.00

5. Fees for issue of Identity card (one time) Rs. 20.00

6. College Security Deposit (one time & refundable)

Rs. 5,000.00

7. PG Students’ Union fees (one time) Rs. 400.00

8. Students’ Dramatic Society fees (one time) Rs. 200.00

9. Students’ Academic Society fees (one time) Rs. 300.00

10. Orissa Red Cross Society fees (one time) Rs. 10.00

11. University Registration Fee (one time) As applicable

Total… .. Rs. 13,430.00

15.3 The courses of study and the registration of candidates for post-graduate study at the respective Colleges in the subjects concerned will be regulated by the University to which the Medical Colleges is affiliated.

15.4 The Medical Fitness Certificate (Appendix No.VI) must be produced by the candidate at the time of joining.

15.5 If any candidate does not join or leaves after joining the PG Course, the seat can not be filled up on any account as per Medical Council of India guidelines and the candidate concerned shall not be considered for selection in the next three academic sessions of the PG Course and the stipend / salary already received by him/her will have to be refunded.

16 ATTENDANCE : 16.1 PG Students are to perform the duties as assigned to them by the Professor

concerned and attend required theory and practical classes and departmental seminars regularly.

16.2 PG Students are entitled to avail 15 days leave during each year of study with the permission of the Head of the Department, but such leave should not exceed 10 days at a stretch.

16.3 Absence beyond the total period of 15 days without prior permission of the Professor & Head of the concerned Department and Principal of the College concerned shall be seriously viewed and the candidate shall forfeit the right to continue.

16.4 All candidates on joining the PG Course shall work full time during the period of training attending not less than 80% of the training during each calendar year.

17 SALARY AND STIPEND : 17.1 PG Students admitted against direct quota seats will be paid stipend at rates

prescribed by the Government of Orissa from time to time subject to satisfactory performance of duties and maintenance of discipline and decorum.

17.2 Stipend / Leave Salary of in-service PG students under employment of Government of Orissa will be governed by the Resolution No.20385/H, Dt: 05-07-1976 & No.38447/F, Dt: 29-07-1980 and such other Government orders as may be issued from time to time.

17.3 The period of PG study of In-service category of candidates under regular employment of Government of Orissa (not on adhoc or contractual basis) admitted into PG Courses shall be governed as per the existing service rules and executive instructions thereon.

18 HOSTEL : 18.1 Hostel accommodation being limited in all Colleges, cannot be guaranteed for

all and allotment of seats in the Hostel will be made by the principal of the concerned College to the needy and deserving students according to availability of seats.

18.2 Fees to be paid for hostel accommodation :

(As per Government Resolution No.16956 / H, dated: 08-05-02)

19 MISCELLANEOUS : 19.1 No correspondence of any kind will be entertained.

19.2 All PG Degree holders when appointed to the post of specialist in the relevant disciplines and opt not to join the same shall be liable to refund the leave salary/pay and allowances actually paid to him/her during the period of study besides such disciplinary action as the Government may decide.

19.3 Without prejudice to the conditions stipulated for submission of application/ selection/admission in the foregoing paragraphs of this prospectus, a candidate who is suffering/has suffered from mental disease, drug addiction or has been convicted for any criminal offence shall not be selected/admitted and will be disqualified for prosecuting the course further even though he/she may have been eligible for selection/admission under the provision of this prospectus. Concealment/misrepresentation about mental illness, drug addiction and criminal conviction shall be liable for disqualification.

19.4 A selected candidate shall be required to produce all original documents including the Original College Leaving Certificate/Transfer Certificate at the time of Counselling. He/She has to appear before a Medical Board(s) constituted for the purpose to decide his/her Medical Fitness.

1 Hostel Fees Per annum Rs 1500/-

2 Hostel Fund Per annum Rs. 600/-

3 Common Room Fees Per annum Rs. 500/-

4 Hostel Caution Money (refundable)

One time Rs.1000/-

5 Electricity and Water Charges) Per annum Rs.5000/-

TOTAL Rs. 8600/-

19.5 In all matters relating to eligibility or otherwise of a candidate for registration, sitting in entrance examination, selection and admission into PG courses, the decision of selection committee shall be final.

19.6 If any candidate does not receive his/her admit card/Hall Ticket, he/she can contact personally to the Convenor, PG (Medical) Selection Committee – 2009, two days before the commencement of the Entrance Examination for issue of a duplicate Admit Card. Such candidates are required to submit an application along with two attested colour 40x50 mm size photographs and the Acknowledgement Card.

19.7 All admissions are subject to production of Medical Fitness Certificate in the form as in Appendix – VI.

20 POST P.G. MANDATORY POSTING OF CANDIDATES 20.1 After successful completion of three year course and passing the examination in

the concern subject both the in-service & direct candidates shall have to work for a period of two years in KBK/ Tribal areas. Candidates who are not in the service (Direct candidate) will be posted on contractual basis depending on the vacancy available for a period of two years in KBK/Tribal areas. In-service candidates those who have not posted in KBK / Tribal areas earlier will be posted to KBK / Tribal areas on priority. In case the required number of vacancies are not available in the KBK / Tribal districts, the remaining candidates i.e. surplus In-service as well as direct candidates if any will be posted to the rural areas of Non-KBK/Tribal districts. (Vide Resolution No. ME-II-IXM- 155/2005-869/ H Dated 12.01.06). This will be considered as post-PG Mandatory Service or PPMS. Each candidate is to furnish an undertaking to that effect as per Appendix-VII and to execute a bond as would be decided by the Govt. in future.

20.2. They will be allotted their place of posting with the concerned C.D.M.Os in accordance with the principles laid down by authorities. The candidates are to report to the concerned C.D.M.Os within 10 days or as will be directed by the Govt.

20.3. The candidates admitted to the non-clinical (Anatomy, Physiology and Biochemistry) and Para-clinical (Pharmacology, Pathology, Microbiology, S.P.M and F.M.T) disciplines must work for two years in the concerned disciplines in the Medical Colleges with consolidated salaries / regular pay at par with other clinical disciplines and the period will be treated as equivalent to the two year post-PG mandatory peripheral service or as will be decided by the Govt. from time to time.

20.4 The Direct candidates not in service will be appointed on contractual basis for two years and will be paid consolidated pay as will be decided by the Government. The period of their service shall not in any way count towards seniority and other service benefits later. For Direct Candidates already in Government Service as well as In-service candidates, the two year mandatory service in identified areas will be counted as part of their regular service.

20.5 The candidate who has not joined the two years PPMS or discontinued before completion of two years PPMS shall not be eligible for getting PG Degree certificate either Provisional or Final or CLC/Conduct Certificates from the concern University or College. In addition to that the direct candidate who has not joined or discontinued after joining PPMS is liable to refund the entire pay / consolidated pay / stipend etc., as received by him / her during the P.G. Course.

20.6 Provision of Post PG mandatory service will not apply to the candidates who are admitted under the All India Quota.

20.7. On completion of two years PPMS, the candidates will obtain certificate from the CDMOs/ Head of Department of Medical Colleges indicating that they have

rendered Post PG Mandatory Service (PPMS) indicating that they have not availed any kind of leave other than CL (15 days at the maximum) and Earned Leave (30 days at the maximum). In case the period of earned leave exceed 60 days during two years of PPMS, the term of mandatory service shall be extended co-terminus with the leave availed for the period beyond 60 days .

20.8. The Principals of Medical Colleges will not issue CLC and Conduct Certificate to any candidate completed the P.G. Course and will also write to the concerned University to publish the result in time but not to issue any certificate until the candidate has completed two years Post-P.G. Mandatory Service.

APPENDIX – 1 (A) The College wise and Subject wise distribution of seats available (including

seats reserved for Candidates selected on All India Basis) for PG Admission, Orissa for the year – 2010.

IN – SERVICE DIRECT ALL INDIA QUOTA

SL. NO. SUBJECT

SCB

VSS

MK

CG

TO

TA

L

SCB

VSS

MK

CG

TO

TA

L

OR

ISSA

Q

UO

TA

SC

B

VSS

MK

CG

TO

TA

L

GR

AN

D

TO

TA

L

NON – CLINICAL

1 Anatomy - - 1 1 1 - - 1 2 1 1 - 2 4

2 Physiology - - - - 1 - - 1 1 1 1 1 3 4

3 Bio-Chemistry - 1 - 1 1 - - 1 2 1 - 1 2 4

PARA – CLINICAL

4 Pharmacology 1 - 1 2 - 1 - 1 3 1 1 1 3 6

5 Pathology 1 1 1 3 1 1 - 2 5 2 2 1 5 10

6 Microbiology 1 - 1 2 1 - - 1 3 2 - - 2 5

7 F.M.T. - - - - 1 - 1 2 2 1 - 1 2 4

8 S.P.M. 1 - - 1 - 1 1 2 3 1 1 1 3 6

CLINICAL

9 Gen. Medicine 4 3 3 10 3 3 3 9 19 7 6 6 19 38

10 Paediatrics 4 1 2 7 3 2 1 6 13 7 3 3 13 26

11 Psychiatry 1 - - 1 - - - - 1 1 - - 1 2

12 TB & Chest Disease 1 1 - 2 1 - - 1 3 2 1 - 3 6

13 Skin & VD 1 - 1 2 1 - - 1 3 2 - - 2 5

14 Gen. Surgery 3 3 3 9 4 3 3 10 19 7 6 6 19 38

15 Ortho. Surgery 1 - 1 2 1 1 - 2 4 2 1 1 4 8

16 Obst. & Gynaec. 4 3 1 8 4 2 2 8 16 8 5 3 16 32

17 Ophthalmology 1 1 1 3 1 1 2 4 7 2 2 3 7 14

18 E.N.T 1 - - 1 - 1 1 2 3 1 1 1 3 6

19 Anaesthesiology 3 - 1 4 3 1 1 5 9 6 1 2 9 18

20 Radio-diagnosis 1 1 - 2 1 - - 1 3 2 1 - 3 6

21 Radio-therapy 1 - - 1 1 - - 1 2 2 - - 2 4

TOTAL 30 15 17 62 29 17 15 61 123 59 33 31 123 246

All the P.G. Courses are recognized by G.O.I except 4 Microbiology seats and 6

Anaesthesiology seats at S.C.B. M.C, Cuttack are permitted by G.O.I. during 2009.

APPENDIX – 1 (B) Distribution of reservation of seats for ST / SC / PH / DF candidates for PG

admission for the year 2010. IN – SERVICE DIRECT SL.

No. SUBJECT SCB VSS MKCG TOTAL SCB VSS MKCG TOTALNON – CLINICAL

1. Anatomy - - 1(GN) 1 1(S.T) - - 1 2. Physiology - - - - 1(S.C) - - 1 3. Bio-Chemistry - 1(S.T) - 1 1(GN) - - 1

PARA – CLINICAL 4. Pharmacology 1(PH) - 1 (ST) 2 - 1(SC) - 1 5. Pathology 1(ST) 1(GN) 1(GN) 3 1(DF) 1(GN) - 2 6. Microbiology 1(ST) - 1(GN) 2 1(GN) - - 1 7. F.M.T. - - - - 1(GN) - 1(ST) 2 8. S.P.M. 1(GN) - - 1 - 1 (PH) 1(GN) 2

CLINICAL

9. Gen. Medicine 3(GN) 1(SC)

2(GN) 1(ST)

2(GN) 1(ST)

10

2(GN) 1(ST)

2(GN) 1(DF)

3(GN) 9

10. Paediatrics 4(GN)

1(GN)

1(GN) 1 (SC) 7 2(GN)

1(SC) 1(GN) 1(ST) 1(GN) 6

11. Psychiatry 1(GN) - - 1 - - - -

12. TB & Chest Disease 1(GN) 1(GN) - 2 1(GN) - - 1

13. Skin & VD 1(ST) - 1(GN) 2 1(GN) - - 1

14. Gen. Surgery 3(GN)

3(GN)

2(GN) 1(SC)

9

3(GN) 1(ST)

3(GN)

2(GN) 1(SC)

10

15. Ortho. Surgery 1(GN) - 1(GN) 2 1(GN) 1(SC) - 2

16. Obst. & Gynaecology

3(GN) 1(ST)

3(GN)

1(PH) 8 4(GN)

2(GN)

2(GN)

8

17. Ophthalmology 1(GN) 1(GN) 1(GN) 3 1(GN) 1(GN)

1(GN) 1(ST)

4

18. E.N.T 1(SC) - - 1 - 1(GN) 1(GN) 2

19. Anaesthesiology 3(GN) - 1(GN) 4 3(GN) 1(ST) 1(PH) 5

20. Radio-diagnosis 1(GN) 1(SC) - 2 1(GN) - - 1

21. Radio-therapy 1(GN) - - 1 1(GN) - - 1 TOTAL 30 15 17 62 29 17 15 61

UN-

RESERVED 23 12 12 47 22 11 12 45 RESERVED 7 3 5 15 7 6 3 16 ST (12%) 4 2 2 8 3 2 2 7 SC (8%) 2 1 2 5 2 2 1 5 PH (3%) 1 0 1 2 1 - 1 2 DF (3%) 0 0 0 0 1 1 0 2

APPENDIX – I (C)

Distribution of 3% reserved quota seats for children / spouse of Service Personnel and Ex-service Personnel (from Direct category only). Note: Distribution of reserved seats for above category will be one in each Non-clinical,

Para-clinical and Clinical groups in Medical Colleges as fixed below.

The Selection Committee shall decide the distribution of subjects from each of the above three groups for a particular academic year on rotation basis with reference to the subjects(s) already distributed in previous academic year.

Category Non-clinical & Para

Clinical (1 seat)

Clinical

(1 Seat)

Subject • Biochemistry • Physiology • Anatomy • Pharmacology • Pathology • Micro-biology • Forensic Medicine • Community Medicine

• Gen. Medicine • Paediatrics • Gen. Surgery • Ortho. Surgery • Ophthalmology • ENT • Anaesthesiology • Radio-diagnosis

College SCB VSS

For 2010 Pathology Gen. Medicine

Note: Distribution of reserve seats for above category will be one each in Non-clinical / Para -clinical

& one in clinical group in Medical Colleges as fixed above. The Selection Committee shall decide the distribution of subject from each of the above two groups for a particular academic year on rotation basis with reference to the subject (S) already distributed in previous academic year.

.

APPENDIX – 1 (D) Distribution of reserve seats for Physically Handicapped (PH) Candidates

(Both from In-Service and Direct Category) For the In-service & direct candidate the choice should be from any of the Non-clinical, para-clinical and Clinical subjects (as defined by MCI Regulation, 1977) which should not overlap with the distribution/allotment for reserved category of children of service personnel and Ex-service personnel.

For In-service PH Candidates Category Non-clinical &

Para-Clinical (1 seat)

Clinical (1 seat)

Subject • Microbiology • Pathology • Anatomy • Pharmacology

• Gen.Medicine • Paediatrics • Psychiatry • TB & CD • Gen. Surgery • Obst. & Gynae. • Ophthalmology • ENT • Anaesthesiology • Radio-diagnosis • Radio-therapy

College SCB MKCG 2010 Pharmacology Obst. & Gynae.

For Direct PH Candidate

Category Non-clinical & Para-Clinical

(1 seat)

Clinical (1 seat)

Subject • Physiology • Biochemistry • Pharmacology • Pathology • Microbiology • FMT • Community

Medicine

• Gen. Medicine • Paediatrics • TB & Chest Dis. • Skin & VD • Gen. Surgery • Orthopaedics • Obst. & Gynae. • Ophthalmology • Anaesthesiology • Radio-diagnosis

College VSS MKCG 2010 Community

Medicine Anaesthesiology

Note: Distribution of reserve seats for above category will be one in each Non-clinical / Para -clinical

& one in clinical group in Medical Colleges as fixed above. The Selection Committee shall decide the distribution of subject from each of the above two groups for a particular academic year on rotation basis with reference to the subject (S) already distributed in previous academic year.

APPENDIX – II

SL. NO. SUBJECT NO. OF QUESTIONS

PART-1 (Non-Clinical) 1. Anatomy 20 2. Physiology 20 3. Bio-Chemistry 20 PARA-CLINICAL

4. Pharmacology 20 5. Pathology 20 6. Microbiology 15 7. F.M.T. 15 8. S.P.M. 20 Total Number of Part-I Questions 150 PART-II (Clinical)

9. Gen. Medicine, Skin & VD & TB & Chest Diseases

45

10. Paediatrics 10 11. Psychiatry 9 12. Gen.Surgery & Orthopaedic Surgery 35 13. Obst. & Gynecology 15 14. Ophthalmology 8 15. E.N.T. 8 16. Anaesthesiology 8 17. Radio-diagnosis 6 18. Radio-therapy 6

Total Number of Part-II Questions 150 TOTAL NUMBER OF QUESTIONS 300

APPENDIX – III (A) CLAUSES 11.2 OF Prospectus – 2010

RURAL/TRIBAL/BACKWARDS AREA SERVICE CERTIFICATE (Including the leave period)

Certified that Dr.________________________________________________ has actually worked as

_________________________ (designation) in the Medical Institution(s) detailed below (as per entry

in service book), excluding the total period leave availed by him/her in excess of one month in a year

as; per G.O. No.325 / H, dated:3rd January 1997.

A. Details of Institution Served as per t6he service record: Total Duration

of Service Name of the

Medical Institution(s)

Block &

District

Nature of Service (Adhoc/Temporary/ Contractual/Regula

r)

Date of Joining

Date of Relief

Y M D

B. Details of Leave Period exceeding one month (As per the record in the Service

Book)

Total Duration of Service

Name of the Medical

Institution(s)

Block &

District

Nature of Service (Adhoc/Temporary/ Contractual/Regula

r)

Date of Relief to proceed on leave

Date of Joining

after availing

leave

Y M D

Place: Date:

Signature of C.D.M.O. / Head of the Office (Name)

Seal Memo No._________/ Dated the _______________________

Copy to the Doctor concerned with reference to his/her application dated________ Signature of C.D.M.O. / Head of the Office

(Name) Seal

APPENDIX – III (B) (Clause 5 OF Prospectus – 2010)

FORM NO.III (The Orissa Miscellaneous Certificate Rules, 1984)

Office of the ____________________________________________________________

Miscellaneous Certificate Case No.____________________________________ of _________.

RESIDENT / NATIVITY CERTIFICATE

This is to certify that Shri/Smt./Miss

__________________________________________ son/daughter/wife of Shri __________________________________________________ is a native of the Dist of ______________________________ in the State of Orissa and he/she /

his/her family ordinarily resides in Village/Town: __________________________ PS:__________________________ Tehsil

____________________________________ in the District of ________________________ for the period from __________________ to

____________________ The certificate is granted only for the purpose of Full Signature of the Applicant Signature of the Revenue Officer Date: ___________________ Date: _____________________ Round Seal of the Office Designation (With Seal of the Office) Note: 1. “Revenue Officer” means the Chief Officer-in-charge of Revenue Administration in the

District, Sub-division or Tehsil and includes and Additional District Magistrate and Additional Tahasildar.

2. No part of the form should be mutilated in any manner. In case of mutilation the candidate is liable to be rejected.

APPENDIX – III (C) (Clause 6.3 OF Prospectus – 2010)

FORM NO.V Form of Caste Certificate to be produced by a candidate belonging to Scheduled Caste or Scheduled Tribe in support of his / her claim, as per Orissa Caste Certificate (for SC & ST) Rules, 1980. Office of the _____________________________________________________ Miscellaneous Certificate Case No. _____________ of __________.

TRIBE / CASTE CERTIFICATE This is to certify that Shri/Smt/Miss ___________________________________________

son/daughter/wife of Shri ___________________________________________________ of

Village/Town ____________________________, P.S.:_________________________

Tehsil:_______________________ in the District of __________________________ of the State of

Orissa belongs to the _________________________________ Caste/Tribe, which is recognized as

Scheduled Caste / Scheduled Tribe under the Constitution (Scheduled Castes) Order, 1950 / the

Constitution (Scheduled Tribes) order, 1950 as amended by the Scheduled and Scheduled Tribes

(Amendment) Order Act 1976.

Shri/Smt./Miss _______________________________________ and his/her family ordinarily reside in Village/Town: ____________________ P.S.:______________, Tehsil: _____________ in the District of ________________. Full Signature of the Applicant Signature of the Revenue Officer Date: ___________________ Date :_____________________ Round Seal of the Office Designation (With Seal of the Office) Note: This Certificate should be issued by the Tahasildar. No part of the form should be mutilated in any manner. In case of mutilation the certificate is liable to be rejected.

APPENDIX – III (D) (Clause 6.4 of Prospectus – 2010)

CERTIFICATE OF DEFENCE SERVICE (OF CANDIDATE’S PARENT / SPOUSE)

1. Full Name of Employee / Person :

2. Permanent Address as per service records :

3. Whether serving/ retired / deceased / permanently disabled / killed in war / hostilities

4. Rank in Defence Service :

5. Full Name of the Candidate :

6. Relationship of the employee / person with the candidate :

7. Present place of posting including details of unit (in case of serving personnel) :

8. Last place of posting including details of Unit (in case of retired / killed in war / hostilities / deceased personnel)

Full Signature of Candidate’s Parent / Spouse Date: ___________________

Full Signature of Station Commander/Office Commanding/

Officer-in-charge/Secretary Zilla/Rajya Sainik Board Date: __________________

Designation (With Office Seal)

APPENDIX – IV

(Clauses 7.13 & 6.1.3 of Prospectus – 2010)

SPONSORING CERTIFICATE This is to certify that Dr. ________________________________________ whose

appointing authority is ________________________________________ and who

at present posted as (Designation) _________________________at (name of the

Place) _____________________________________________________ has been

sponsored by (employing organization) ________________________________

To take the course of studies leading PG Degree in the Government Medical Colleges of Orissa for a period of three years subject to his/her eligibility for admission into the course. Place : Signature of the Appointing Authority Date : Designation Seal of the Office

APPENDIX – V (Clause 5.5.1 of Prospectus 2010)

(A) PARTICULARS OF THE UNDER – GRADUATE MEDICAL CARRIER 1. Name of the applicant : 2. Name and Address of the Medical College

where graduated:

3. Name of the University : Period of Study with Dates (Month/Year)

Name of the examination passed

From To

Month and Year of passing the examination

No. of chances/ attempts taken

to pass First MBBS/ Professional

Second MBBS/ Professional

Third MBBS/ Third Professional (Part-I)

Final MBBS/ Third Professional (Part-II)

(B) PARTICULARS OF COMPULSORY ROTATING HOUSEMANSHIP / INTERNSHIP

(To be mentioned chronologically) 1. Name of the candidate 2. Name of the Institution / Hospital 3. Period of Housemanship / Internship from…………………… to……………………

Period of Training Sl. No. Department/Discipline From To

Signature of the candidate Date: ……………………….

APPENDIX – VI POST-GRADUATE (MEDICAL) SELECTION – 2010, ORISSA

MEDICAL CERTIFICATE Certified that this day I examined __________________________________ for physical fitness for PG (Medical) Studies. The findings are as detailed below.

Name and Address:

_____________________________________

_____________________________________

_____________________________________

1. Height (Not less than 150cm for male & 140cm for female candidates) :________Cm

2. Weight (Not less than 40 Kg) : ________Kg

3. (a) Chest measurement (Not less than 70 cm) : ________Cm

(b) Chest expansion (Not less than 4.5 cm) : ________Cm

4. Condition of Heart (Abnormality, if any) :___________________________________

5. Conditions of Lungs ( -do- ) : ___________________________________

6. (a) Vision : In case of defective vision it must be corrected to

6/9 in both eyes and 6/6 in the better eye: _________________________________

(b) Colour Blindness: ___________________________________________________

7. Hearing (whether normal, where defective it must be corrected):_________________

8. Blood Group :_________________________________________________________

9. Hernia, Hydrocele and piles (in any, to be corrected before joining):_______________

10. History / Symptom of Epileptic fits, if any :___________________________________

11. History / Symptom of Mental disease, if any :________________________________

12. Orthopedic defects, if any :_____________________________________________

Remarks: The Candidate has fulfilled (fit) / not fulfilled (unfit) the prescribed standards as stipulated

in this form for Post Graduate (Medical) studies.

Full Signature of the Candidate

Signature of Government Medical Officer

Date: __________________ (Not below the rank of Sub-Divisional Medical Officer)

with Regn. No. & Seal

Date: ___________________

Photograph of the

candidate to be pasted here should be signed by the Govt.

Medical Officer with Seal

APPENDIX-VII

(Under clause 20.1)

Under taking for Post PG Mandatory Service

I Dr. ………………………………………………… an In-service/ Direct candidate

undertakes that, after passing out the Post Graduate Course, I will serve for a period of two years or

as would be decided by the Govt., in H & F.W. Department as a Post P.G Mandatory Service and

would execute the required Bond to be prescribed by the Govt. for the purpose.

Signature of the Applicant

Date:

P.G. (M) – 2010

APPLICATION FORM FOR

SELECTION INTO THE POST-GRADUATE MEDICAL COURSES

OF ORISSA - 2010 AT

S.C.B. MEDICAL COLLEGE, CUTTACK / V.S.S. MEDICAL COLLEGE, BURLA /

M.K.C.G. MEDICAL COLLEGE, BERHAMPUR

APPLIED FOR (ticks the requisite cell and cross whichever is not applicable)

GENERAL ST SC PH DEFENCE

IN-SERVICE

DIRECT

NAME OF THE CANDIDATE IN FULL …………………………………………………………………

(To be filled up by the Candidate in BLOCK LETTERS)

For Office Use Only

REFERENCE No. …………………… ROLL No. ………………………

Form Rejected / Accepted

Ineligible / Eligible

Category

R/T/B Service Credit Marks

FORM OF APPLICATION FOR SELECTION IN POST-GRADUATE COURSES, ORISSA 2010

AT: S.C.B. MEDICAL COLLEGE, CUTTACK, V.S.S. MEDICAL COLLEGE, BURLA

M.K.C.G. MEDICAL COLLEGE, BERHAMPUR (See the instructions in the last page before filling up the form) 1. Full Name:

(Write your name in capital letters as given in the records of Board of Secondary Education or equivalent examining body. One box should be left blank between two parts of the name. In case the name is long and cannot be accommodated within the boxes provided, you should abbreviate the middle name.) 2. Address of Correspondence:

PIN

3. Date of Birth

Day Month Year

4. Name of the Father:

5. Name of the Husband: (in case of married female applicant only) 6. Permanent Address of Father/Husband: Village Post Office

Block Police Station

District State & Pin code

7. Permanent Address of the Applicant: Village Post Office

Block Police Station

District State & Pin code

Telegraph Office

Paste (do not pin) a recent photograph

(size 40 x 50 mm duly signed by applicant on the top and must be

attested by a Gazetted Officer with seal after

pasting.

8. Category: In-service Direct Sex

9. Reserved Category:

S.T. S.C. P.H. Defence

10. Type of Service:

Orissa Govt. Central Govt. Private Sector Any other

11. High School/10th Class Pass details:

Block District State Year of Passing Division/Class

12. M.B.B.S. from which State: Native of which State: 13. Medical Registration: Central / State (Name of the Board)

14. M.B.B.S. particulars: Name of College/Institution District State University Year of

passing

17. Compulsory Rotating Housemanship/Internship details: Name of the College/Hospital/Institution

State

Medical Registration Status Permanent / Provisional

Registration No. with date

Name of the Council

19. Previous Post-graduation (Medical) / Diploma / DPH status: Year of selection

State/ Central

Discipline Institution/ College And State

Taken admission/ Refused

Continuing/ Discontinued

Date of discontinuing the last P.G./Diploma/DPH, if any:

15. Date of Completion/Expected date of Completion of Internship / Housemanship

Day Month Year

16. Total Period of service Days Months Years

18. Total Period of service R/T/B areas

Days Months Years

20. Present Service Status

20 (A): SERVICE PARTICULARS IN ORISSA (UP TO 31ST DECEMBER 2008)

Name of the Medical Institution Block/NAC/ Municipality/Dist

Date of Joining

Date of Relief

Duration of Service

20 (B): LEAVE PARTICULARS (UP TO 31ST DECEMBER 2008) (If more than 30 days at a stretch except maternity leave)

Name of the Medical Institution Block/NAC/ Municipality/Dist

From To Duration

20 (C): SERVICE ABSTRACT

Up to 31st December 2008 Total Service From To

Duration of Service (A)

Total Leave Period (B)

Duration of Service Excluding Leave (A– B)

Total Period of Service in R/T/B areas

21. Details of Bank Draft:

Amount Bank Draft. No. Date Issuing Branch

22. List of documents attached with Application Form (Enclosures to be numbered by the candidate)

Sl. No.

Documents Type Enclosure No.

1. H.S.C or equivalent Exam. Pass Certificate Attested True Copy

2. M.B.B.S. Degree / Provisional MBBS Certificate Attested True Copy

3. Compulsory Rotating Internship/ Housemanship Attested True Copy

4. Permanent Medical Registration Certificate Attested True Copy

5 Scheduled Tribe /Caste Certificate Attested True Copy

6 Physically Handicapped Certificate Attested True Copy

7 Certificate of Children of Service/Ex-service personnel Attested True Copy

8 Expected date of completion of Internship/Housemanship Original

9 Service Certificate Original

10 Sponsoring Letter Original

11 Particulars of Undergraduate Medical Career Original

12 Particulars of the Compulsory Rotating Housemanship Original

13 Resident/Nativity Certificate Original

14 Certificate of Employment of Parents/Spouse Original

15 Any other Original

DECLARATION 1. I declare that the statements furnished by me in the Application and the attached documents

are true in all respects to the best of my knowledge and belief and I undertake that if subsequent to my selection / admission, I am found to have given wrong information with regard to any document produced by me in connection with my selection / admission, then my name shall be immediately removed from the Institution and whatsoever legal action due shall be taken against me.

2. I submit myself to the jurisdiction of the P.G. Selection Committee, Orissa - 2009 and declare that I shall abide by its rules and regulations as laid down in the P.G (Medical) prospectus 2009 and that the decision of the committee about my position in the merit list shall be binding on me.

3. In the event of my being found ineligible at a later date, I understand that I shall be denied the opportunity of selection / admission and my selection / admission shall be cancelled even if, I am selected and admitted.

4. I agree to abide by the rules and regulations of the Institution I am admitted to and pay all fees and other dues as laid down by the Institution or would become due under these rules and I agree to withdraw myself from the Institution should the Authority decide that such withdrawal is necessary in the interest of the Institution.

I hereby certify that I have completed the Application Form in all respects with requisite documents as per details given above and my application contains ………….enclosures excluding the Application Form.

Signature of the attesting Signature of the Applicant in full Gazetted Officer Date……………………………. (Full name and Designation) (In presence of the attesting officer)

Official seal Instructions regarding filling up of Application Form and Appendices:

1. Cross (X) the box or fill up the box in capital letters, wherever applicable.

2. The signature and official seal of the attestation on the photograph should be placed such that these extending part to the application form, admit card and attendance card.

3. Write your name in capital letters as given in the records of B.S.E. or equivalent examining body. One box should be left blank between two parts of the name. In case the name is long and cannot be accommodated within the boxes provided, you should abbreviate the middle name.

4. Write your name in the Admit Card and Attendance Card and give your signature in the Admit Card and write your full correspondence address and affix the requisite postage stamps.

5. The requisite forms should be detached from the Appendices and used wherever applicable along with the application.

ADDRESS SLIP The Candidate shall fill up his/her name and correct present address for correspondence on

the address slip below (His/Her Reference No. is to be filled by the Office) For Office use Address for Correspondence

Reference No.: Nature of Despatch: Date of Despatch:

To Reference No. Dr.

C/o

At

P.O.

District State

PIN Telegraph Office



C/o

At

P.O.

District State

PIN

Telegraph Office



C/o

At

P.O.

District State

PIN

Telegraph Office



C/o

At

P.O.

District State

PIN

Telegraph Office

POST-GRADUATE (MEDICAL) SELECTION – 2010

ACKNOWLEDGEMENT CARD

Your Application Form of Post-Graduate (Medical) Selection has been

Received on…………………………………………………………………

You have been assigned Reference No…………………………………..

Please quote this number for future reference.

Convenor, PG (Medical) Selection Committee-2010,

S.C.B. Medical College, Cuttack-760 004 (Orissa) Note: This card with your address for correspondence properly written on the reverse and duly stamped should be sent along with the application.

To

________________________________________

________________________________________

________________________________________

_________________________PIN ___________

(Write your name and address on the card) From: Convenor, PG (Medical) Selection Committee-2009, M.K.C.G. Medical College, Brahmapur-760 004.

Affix Postage

Stamps of 4.00

Paste (do not pin) a recent photograph (size 40 x 50 mm).

Paste (do not pin) Photograph (size 40

× 50 mm).

ENTRANCE EXAMINATION FOR POST-GRADUATE (MEDICAL) SELECTION – 2009

ADMIT CARD Name of the Candidate: Dr. …………………………………………………………………

(The applicant to write his/her name)

Roll No…………………………………………

Examination Centre

Time: 10:00 AM Date -

NOTE:

1. Issue of this card does not necessarily mean acceptance of eligibility.

2. Please do not detach the Attendance Card. Convenor,

PG (Medical) Selection Committee-2009, M.K.C.G. Medical College, Brahmapur.

Full signature of the Candidate (Not in Capital Letters)

………………………………………………………………………………………………… ENTRANCE EXAMINATION FOR POST-GRADUATE (MEDICAL) SELECTION – 2009

ATTENDANCE CARD Name of the Candidate Dr. ……………………………………………………………………. (The applicant to write his/her name)

Roll No…………………………………………

Examination Centre

Q & A Booklet No.

Hall No. Seat No. Signature of the invigilator

Full signature of the Candidate ….…………………..…Centre

(Do not sign now, to be signed in presence of Invigilator) Hall No…………………….

(p.t.o.)

INSTRUCTION TO THE CANDIDATES

1. Admit card must be produced before the Invigilator / Supervising Officer of the Entrance Examination for verification. A candidate without the valid Admit Card shall be debarred from appearing the Entrance Examination.

2. The candidate should report one hour before the commencement of Entrance examination at the center (9.00 A.M.) and occupy his / her seat 15 minutes before the commencement of examination (i.e. 9:45 A.M).

3. No candidate shall be allowed to the examination hall after the commencement of examination. No candidate will be allowed to leave the hall till the end of examination. Temporary absence from the hall for any reason is strictly prohibited.

4. The candidate must observe complete silence and shall concentrate to his / her Q. & A. booklet. Violation of any instruction and adoption of any unfair means on the Examination Hall shall render a candidate liable for cancellation of his/her Q. 7 A. booklet and forfeiture of his/her claim for admission. In this regard the decision of the center Superintendent shall be final.

5. Use blue/black ink ballpoint pen only.

6. The candidates are not allowed to carry any sheet of paper, written or blank, except their Admit Cards to the Examination Hall.

7. No T.A and D.A. will be paid for appearing the Entrance Examination.

8. No mobile phone or any other electronic communication system or calculator shall be allowed into the examination hall.

BY REGISTERED POST

To

________________________________________ ________________________________________

________________________________________

_________________________PIN ___________

From: (Write your name and address on the card) Convenor, PG (Medical) Selection Committee-2009, & Principal, M.K.C.G. Medical College, Brahmapur-760 004, Orissa.