Professional Documents
Culture Documents
Neet Proforma
Neet Proforma
Neet Proforma
izk:i&1
izek.k&i=@vfHkys[kksa dh LØwVuh] laca/kh izksQkekZ
¼fpfdRlk@nar fpfdRlk egkfo|ky;ksa esa izos’k gsrq½
1- p;u ijh{kk gsrq vH;FkhZ ds iath;u dh QksVks ;qDr izfr vFkok izos'k i=A
2- gkbZ Ldwy ,oa gkW;j lsd.s Mjh ¼10$2½ vFkok led{k ijh{kk dh vadlwphA
3- d{kk 11oha dh vadlwph
4- vk;q izek.k ds fy;s gkbZ Ldwy] vFkok led{k ijh{kk mRrh.kZ djus ds izek.k i=@vad
lwph dh ewy izfr ftlesa vk;q dk mYys[k gksA
5- vH;FkhZ dh QksVks ;qDr vkbZMhA
6- e/;izn's k dk ewy fuoklh@LFkkuh; fuoklh gksus laca/kh l{ke vf/kdkjh }kjk tkjh
izek.k&i=A vH;FkhZ ds O;Ld u gksus dh n'kk esa mlds ekrk@firk ds ewy fuoklh izek.k
i= esa vH;FkhZ dk uke vafdr gksA
7- l{ke vf/kdkjh }kjk tkjh e/;izns'k jkT; esa vkjf{kr Js.kh ¼tkfr izek.k&i=½ dk LFkk;h
tkfr izek.k&i=A
8- vkfFkZd :i ls detksj oxZ ¼EWS½ ds vH;fFkZ;ksa dks e/;izn's k jkT; 'kklu ds l{ke
vf/kdkjh }kjk orZeku o"kZ esa tkjh fd;k x;k izek.k i=A
1
9- orZeku o"kZ dk rglhynkj@uk;c rglhynkj }kjk tkjh vk; izek.k&i= vFkok vH;FkhZ
}kjk LogLrk{kfjr ?kks"k.kk i= ¼vU; fiNMk oxZ ds vH;fFkZ;ksa esa dhzeh@ukWudhzeh ys;j ds
fu/kkZj.k gsrq½ ¼;fn ykxw gks½A
10- fnO;kax izoxZ gsrq vkj0ih0MCY;w0Mh0 ,DV 2016 ds vUrxZr cSap ekdZ fMl,fcfyfV ds
fy;s fdlh Hkh jkT; ds fnO;kaxrk dsUnz vFkok dsUnz ljdkj ds fofufnZ"V fnO;kaxrk dsUnz
ls tkjh fd;k x;k fnO;kaxrk dk izek.k i=A
11- lSfud izoxZ ds vH;FkhZ dks dekUMsVa ¼lsokjr lSfud dh n’kk esa½ vFkok ftyk lSfud
dY;k.k cksMZ ¼lsokfuo`Rr vFkok e`r lSfud dh n’kk esa½ }kjk tkjh fd;k x;k izek.k i=]
izk:i 2 ¼v½ ] izk:i 2 ¼c½ vFkok izk:i 2 ¼l½A
12- Lora=rk laxzke lSukuh vH;FkhZ dks lacaf/kr ftyk dysDVªVs }kjk tkjh fd;k x;k izek.k
i=] izk:i&3 A
13- vfuoklh Hkkjrh; dksVs ls lhV vkoafVr gksus dh n'kk esa izkQ
s kekZ 4]5]6 ds vuqlkj fn;k
tkus okyk 'kiFki= A
14- e/; izn’s k ds vU;= fdlh jkT; ls ewy fuoklh ¼LFkkuh; fuoklh izek.k i=½ izkIr ugha
djus laca a/kh ’kiFk i= ,oa fdlh vU; jkT; ls ewy fuoklh dk ykHk ugha fy;s tkus lac/a kh
'kiFki= izkQ
s kekZ&7A
15- lhV fyfoax ckW.M@ xzkeh.k lsok ca/k i= izkQ
s kekZ&8
2
QksVks
3
izk:i&2 ¼v½
¼vuqlwph&3 ¼12½ Lukrd ikB;dze gsrq½
feysVªh ilZu laoxZ ¼,e-ih-½ gsrq izek.k i=
HkwriwoZ lSfud
lanHkZ Øekad--------------------- fnukad---------------------
4
izk:i & 2 ¼c½
¼vuqlwph&3 ¼12½ Lukrd ikB;dze gsrq½
e/;izns'k es@
a e/;izns'k ds ckgj vU; jkT; esa dk;Zjr lSfud
lanHkZ Øekad------------------------- fnukad-------------------------
;g izekf.kr fd;k tkrk gS fd Jh@Jherh---------------------------------------------------------------
--------------tks izos’k ijh{kk NEET UG o"kZ ------------------- ---------------------------------------------------------------------------
--ds vk/kkj ij ------------------------------------------------------ikB~;Øe esa izos'k ds fy;s vH;FkhZ Jh@dqekjh -
-------------------------------------------------------------------------------------------------------- ds firk@ekrk gSa
5
izk:i&2 ¼l½
¼vuqlwph&3 ¼12½ Lukrd ikB;dze gsrq½
HkwriwoZ lSfud }kjk LFkk;h :i ls e/;izns'k esa vf/kokflr gksus laca/kh izek.k i=
esjs le{k izLrqr fd;s x;s izek.k ds vk/kkj ij izekf.kr fd;k tkrk gS fd
Jh@Jherh@dqekjh ¼mEehnokj dk uke½------------------------------------------------------------------------------------------ tks izos’k
ijh{kk NEET UG-o"kZ-------------------------- ds vk/kkj ij ¼ikB;dze dk uke½----------------------------ikB;dze esa
izos’k ds fy, mEehnokj gSa] Jh@Jherh ¼firk@ekrk½-------------------------------------------------------------------------------------
-ds@dh iq=@iq=h gSa] tks Fkylsuk@ok;qlsuk@ukSlsuk esa -------------------in]lfoZl dzekad-------------------------- ds
v/khu lsokjr jgdj lsokfuo`Rr gq, gSa vFkok lsokfuo`fRr ds Ik’pkr@mudh e`R;q ds Ik’pkr~ muds
ifjokjtu -----------------------------------¼LFkku½]rglhy-----------------------ftyk----------------------esa vf/kokflr gks x, gSaA
6
izk:i& 3
¼vuqlwph&3 ¼13½ Lukrd ikB;dze gsrq½
Lora=rk laxzke lsukuh izoxZ gsrq izek.k i=
rFkk
Jh@Jherh ¼vH;FkhZ ds firk@ekrk dk uke½-----------------------------------------------------------------------------------
Jh@Jherh ¼Lora=rk laxzke lsukuh dk uke½ ------------------------------------------------- ds iq=@iq=h gSaA
rFkk
LFkku&&&&&&&&&&&& gLrk{kj %
fnukad&&&&&&&&&&& ¼ftyk dysDVj@ftyk dysDVj }kjk vf/kd`r vf/kdkjh½
dk;kZy; dh Li"V eksgj
7
PROFORMA-4 (izk:i&4)
[As per Schedule 3 item 11(iv) (v) ]
NOTARIZED AFFIDAVIT BY NRI CANDIDATE
(to be executed on rupees 1,000/- non judicial stamp paper)
(For admission in the NRI quota seats in Private Medical and Dental Colleges of MP State)
1) I, (Name of candidate) _______________________ Son of
Shri/Smt._______________________ aged ________ years, who is seeking admission in
_____________________________ course through NEET _______________, NEET Testing
ID ____________ under NRI quota seats in ______________________ private college,
holding ___________________________ passport and residing at
___________________________________, mobile number ________ email id_________ ,
am an NRI.
Proof of being NRI:- (any one)
i) OCI Card
ii) NRI Status certificate issued by embassy/consulate general in the
admission year
iii) Copy of passport
OR
2 Grandparents, (paternal/maternal )
OR
Date
Place Signature of Candidate
Name _____________
Address_____________
Note :-
1. choose any one of the three alternatives applicable.
2. in case the candidate is a minor on 01/04/2018 the affidavit has to be signed by a
parent or legal guardian of the candidate in the proforma given.
8
PROFORMA-5 (izk:i&5)
[As per Schedule 3 item 11(iv) (v) ]
NOTARIZED AFFIDAVIT BY GUARDIAN / SPONSOR
(to be executed on rupees 1,000/- non judicial stamp paper)
(For admission in the NRI quota seats in Private Medical and Dental Colleges of MP State)
1) I, (Name of guardian/ Sponsor) _____________________hereby, declare that Mr/ Ms -----------
------------(Name of candidate) Son of Shri/Smt_____._______________________ aged
________ years, who is seeking admission in _____________________________ course
through NEET _______________, NEET Testing ID ____________ under NRI quota seats in
______________________ private college, holding
_____________________________________ passport and residing at
___________________________________, mobile number ________ email id_________ , is
an NRI.
Proof of being NRI:- (any one)
i) OCI Card
ii) NRI Status certificate issued by embassy/consulate general in the
admission year
iii) Copy of passport
OR
2) He is being sponsored by ____________ Son of /Daughter of___________ who is an NRI and
is related to the candidate by relation as indicated below :-
2 Grandparents, (paternal/maternal )
OR
Date
Place Signature of Legal Guardian/ Sponsor
Name _____________
Address_____________
Note :- Choose any one of the three alternatives applicable..
9
PROFORMA-6 (izk:i&6)
[As per Schedule 3 item 11 (v) ]
NRI/OCI SPONSORSHIP CERTIFICATE
(Applicable for candidates sponsored by NRI/OCI)
The candidate is required to submit the following NRI/OCI sponsorship
certificate from the sponsorer duly notarized in the country of residence of
NRI/OCI at the time of admission.
I, ……………………………………………………………………Son/Daughter of Mr./Mrs.
………………….…….………........ aged about ……………years, do hereby declare that I am
a Non-Resident Indian (NRI)/ an Overseas Citizen of India (OCI) and I am herewith enclosing
photocopy of my valid passport/ OCI card duly counter signed by the Indian embassy/ high
commission.
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(प्रारूप-7)
नोटराइज्ड शपथ-पत्र
मैं..........................................पत्र
ु /पत्र
ु ी /पत्नी श्री...........................................
ननवासी............................मध्
यप्रदे श के चिककत्सा / दं त चिककत्सा महाववघालय में स्
नातक / स्नातकोत्तर
पाठ्रयक्रम में शैक्षणिक सत्र ................... में प्रवेश हे तु अभ्
यथी हूं।
मैंने मध्यप्रदे श शासन चिककत्
सा शशक्षा ववभाग के मध्यप्रदे श चिककत्
सा शशक्षा प्रवेश ननयम 2018 को
भलीभांनत पढ़कर समझ शलया है ।
मैं शपथ पव
ू क
व यह कथन करता /करती हूं कक मैनें अन्यत्र राज्य से स्थानीय ननवासी /मल
ू ननवासीप्रमाि
पत्रप्राप्तनहीं ककयाहै Aएवं मैने अन्यककसीराज्यसे स्थानीयननवासी/मूलननवासीहोने
कालाभप्राप्तनहींककयाहै ।
मैनेंयहभलीभांनतसमझशलयाहै ककमेरेद्वारादीगयीजानकारीगलतपायेजानेपरमेराप्रवेश
ननरस्तकरददयाजायेगा।
नोट :-अभ्यथी के व्यस्क न होने पर शपथपत्र पर हस्ताक्षर अभ्यथी के अविभािक द्िारा ककये
जायेंगे ।
हस्ताक्षर
अभ्यथी/अविभािक
नाम-...........................
पता-..............................
ददनांक-..........................
11
QksVks
izk:i&8
¼vuqlwph&3&11 (i) (ii) Lukrd ikB;dze gsrq½
¼fpfdRlk@nar fpfdRlk egkfo|ky; esa LVsV dksVk vFkok vkWy bf.M;k dksVs ls Lukrd ikB;dze esa
izofs 'kr vH;FkhZds fy;s½
ca/k&i=
lE;d :Ik ls LVkafir ¼ca/k i= dh jkf'k dk 0-5 izfr'kr½
c& fofgr vof/k tks fd 'kkldh;@futh Lukrd ikB~;dze esa izos’k ysus ij ,d o"kZ 'kklu
}kjk fufnZ"V LFkku ij lsok,a u nsus dh fLFkfr esa eSa 'kklu dks :0 10 yk[k ¼vukjf{kr oxZ
gsrq ½ :0 5 yk[k ¼vkjf{kr oxZ gsrq ½ Hkqxrku djus dk opu nsrh@nsrk gwaA
12
l& vU; fiNM+k oxZ ds vH;FkhZ }kjk Nk=o`fRr ;kstuk dk ykHk ysus dh fLFkfr esa fofgr vof/k
tks fd 'kkldh; Lukrd ikB~;dze esa izos’k ysus ij ’kklu }kjk fufnZ"V LFkku ij 2 o"kZ dh
lsok nsus vFkok :0 10 yk[k Hkqxrku djus dk opu nsrk@nsrh gWAwa ,oa futh fpfdRlk
Lukrd ikB~;dze esa izos’k ysus ij 5 o"kZ dh lsok nsus vFkok :0 25 yk[k Hkqxrku djus dk
opu nsrk@nsrh gWAwa futh fpfdRlk egkfo?kky; esa izos'k gksus ij ckWM dk fu"iknu
lapkyd fpfdRlk lsok ds uke ls gksxkA
vFkok
fofgr vof/k tks fd eq[;ea=h es/kkoh fon;kFkhZ ;kstuk@eq[; ea=h tudY;k.k
;kstuk dk ykHk 'kkldh; Lukrd ikB~;dze esa izos’k ysus ij ’kklu }kjk fufnZ"V LFkku ij
2 o"kZ dh lsok nsus vFkok :0 10 yk[k Hkqxrku djus dk opu nsrk@nsrh gWwaA ,oa futh
fpfdRlk Lukrd ikB~;dze esa izos’k ysus ij 5 o"kZ dh lsok nsus vFkok :0 25 yk[k Hkqxrku
djus dk opu nsrk@nsrh gWwaA futh fpfdRlk egkfo?kky; esa izos'k gksus ij ckWM dk
fu"iknu lapkyd fpfdRlk lsok ds uke ls gksxkA
gLrk{kj vkosnd
xokg %&
1-------------------------------------
2-------------------------------------
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