KEAM 2012 Roll No: KEAM: 2012 ADMISSION TO MBBS COURSE 2012

COMMUNITY CERTIFICATE FOR CLAIMING RESERVATION UNDER MINORITY/COMMUNITY QUOTA IN PRIVATE SELF-FINANCING MEDICAL COLLEGES
(G.O.(Rt)No.1814/2012/H&FWD, dated Thiruvananthapuram, 31.05.2012) (G.O.(Rt)No.1985/2012/H&FWD, dated Thiruvananthapuram, 15.06.2012) (G.O.(Rt)No.2023/2012/H&FWD, dated Thiruvananthapuram, 15.06.2012)

Certified that, Sri/Smt/Kum.. Son/Daughter of Sri/Smt... House ... Village ... Taluk . District ... of Kerala State belongs to . Caste, . Religion.

Certified that he/she belongs to . District of Kerala State.

Place : Date :

Signature of Village Officer : Name Designation & Address : :

(Office Seal)

KEAM : 2012 ALLOTMENT TO MBBS COURSE 2012 IN PRIVATE SELF-FINANCING MEDICAL COLLEGES UNDER MINORITY / COMMUNITY QUOTA
(G.O.(Rt)No.1814/2012/H&FWD, dated Thiruvananthapuram, 31.05.2012) (G.O.(Rt)No.1985/2012/H&FWD, dated Thiruvananthapuram, 15.06.2012) (G.O.(Rt)No.2023/2012/H&FWD, dated Thiruvananthapuram, 15.06.2012)

PROFORMA FOR SUBMISSION OF CANDIDATE DETAILS

Name and Address

Roll No. of KEAM 2012

Medical Rank

Minority / Community to which allotment/admission is sought

Details of certificates attached

Place: Date: Signature of candidate

Note:- (i) For claiming Minority/Community quota, attach Community Certificate obtained
from Revenue Officials. (Proforma available in www.cee-kerala.org) (ii) It is compulsory that candidates claiming the above said quota should register online options through the website www.cee.kerala.gov.in for the Colleges/Course concerned on or before 05/07/2012, 5 pm.

(For office use only)

Remarks: Initials: