Procedure ror Change of l\lcntor

Stwk111 has to .tublrut tlus profo,_ dlllJ jiJhd-"IJ oJovo.1111 copy of~f•lllor1 Dtgru Qrnftcau

Studmt Namt VIRE." DER VERMA ID ISO.: 2021 HT7460S

Studmt Email Address: VAOR£NALIXfl<lG\IAU..COM; 2t21HT7460Slli'\\'ILP.BITS-PILA1'1.AC.JN

1\fentor's Qualilication:1\1BBS, DNB, DCB

I. The Mentor for B S propmrnc <hould h.-c ...,..,,., cducolJolW q..J1ric.11on of the IC>d of ln1Cgratcd Fim Degree of BITS
or its cqwvalcnt such os 8 6/BITS 8 SJB Tcch.IM.ScJA.M-l.E. Cle. Pr<fcn:noc "'II be iJVCn to opphcanLS luving a sui13blc Mentor
from the S:tmC cmploy11l& Of'lln17AltOn In QSC 1'.1enlor IS not chosen from lhc ~me cmpl0)1ng org1n.1.Ut1on :as Wt or the student. It
is mand3tory for the student to io•c >dcquotc JUstlrtallOft ut a scp>r>IC doaomcnt. "hoch muJI be duly f°"'3<dcd by the applicant's
employer.

2- The Mc- chosen for MS I M Plul prognmmc sbocld ha>e 1I1U111m.1n ~ qU3lorlQI.., of the lc>cl of Higher Degree
of BITS or 11.S cqwnlcDI 5UCh., M E. /MS I ~tTech. / M.Pbd. . ~lD CIC HO"<>cr. scnoor p<ofcssoomh holding a Fint Dcgrcc of
BITS or 11.Scqwnlcn1 5UCh .. BE. / BTcch. / M.SC./~lB.A. · ~tBBS I MCA <t< and lu>ong • nurumumof J().ycan of
rde\'3Dt •td. c~icncc. DY) abo be Pfopo5Cd a mc•n Pn:lamce •ill be J:l\CO IO wt.anu bt"l.Dg a suitable ~1ealor from
the S3.mC ••>'II& orp•1Wl(IO la aoc Mcotor is DOl cbosal ~ lbc ..me cmplo)'lllJ orpai<>tioo u lh>t of the "'""'"· ot u
mardauwy f<J< the studcal to SJ>< ldcq= JU>llfaboll ma SCI""* documcal. "bich """' be doly fOf"-.rded by the applicant's
employer.

MENTOR'S PROFORMA
Declaration by the 1\1entor
I have nolOd that my name has been suggested as ~ientor. I ha'e gone lhrouJh the lnronm11on for Mentor glven belO\\' and I am
willing to lllkc up thi' m1gnntcnt and "·ill d1sch:uge all n:sponstbtlit.ies reqwred thereof.
Name or Mentor DR ABHIJEET SINGH

Dcsignobon of Mcnror CONSULTANT PEDIATRICIA.'<

Orpniwlon of ~lent« · AIMS HOSPITAL, OO~IBl\'LI

Qaalificaboo of M<lllOr MBBS, OCH. D~'B

~1-WortExpcnat« Yan I~---

Ih I I 0 16 I
Mentor addms: PEDIATIUCS OPD. nRST FLOOR. AntS UOSPITAL, ~UDC. ~Ill.AP !'AGAR. OO~IBIVU
EAST. 421203. MAHARASTRA
City OOMBIVLI EAST

S1.11C MAHARASTRA

PmCodc 421203

Mcnlor's E-tNJI ..&.lms:

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