NATIONAL MEDICAL COMMISSION

APPLICATION FOR ESTABLISHING A NEW MEDICAL COLLEGE (AY 2022-23)

PARTICULARS OF THE APPLICANT

1. NAME OF THEAPPLICANT
(STATE GOVERNMENT./UNION TERRITORY/UNIVERISTY/
SOCIETY/TRUST/COMPANY/CONSORTIUM)
(IN BLOCK LETTERS)

2. ADDRESS
(NO., STREET, CITY, PINCODE,
TELEPHONE NOS., FAX NO.) (IN
BLOCK LETTERS)

3. ADDRESS OF REGISTERED OFFICE (NO.,

STREET, CITY, PINCODE, TELEPHONE,
TELEX, TELEFAX)

4. CONSTITUTION
(STATE GOVERNMENT/UNION TERRITORY/UNIVERISTY AUTONOMOUS BODY, SOCIETY,
TRUST,COMPANY, CONSORTIUM)(Required to also upload Certified copy of Bye
Laws/Memorandum and Articles of Association/ Trustdeed).

5. REGISTRATION/INCORPORATION
(NUMBER AND DATE)(Required to also upload Certified copy of Certificate
ofregistration/incorporation)

6. NAME OFAFFILIATINGUNIVERSITY (Required to also upload aCertified copy of the consent of

affiliation issued by affiliating University)

COA issued date (Calendar)

PART-I

7. CATEGORY OF APPLICANT
(STATE GOVERNMENT/UNION TERRITORY/
UNIVERISTY/SOCIETY/TRUST/COMPANY/CONSORTIUM)

8. BASIC INFASTRUCTURAL
FACILITIES AVAILABLE FOR MEDICAL COLLEGE AND ATTACHEDHOSPITAL
(Upload the required Information)

9. MANAGERIAL CAPABILITY:-
 COMPOSITION OF THE SOCIETY/TRUST/COMPANY/CONSORTIUM
 PARTICULARS OF MEMBERS OF THE SOCIETY/TRUST, HEAD OR PROJECT DIRECTOR
OF THE PROPOSED MEDICALCOLLEGE,
 HEAD OF THE EXISTING HOSPITAL;THEIR QUALIFICATION AND EXPERIENCE IN THE
FIELD OF MEDICAL EDUCTION.
(Upload the required Information)

10. FINANCIALCAPABILITY
  BALANCE SHEET FOR THE LAST 3 YEARS TO BE PROVIDED IF THE APPLICANT ISA
SOCIETY/TRUST.
 DETAILS OF THE RESOURCES TO BE GIVEN IN DETAIL.
(Upload Annual reports and Audited Balance sheets for the last threeyears,authorization letter addressed
to the bankers of the applicant authorising the National Medical Commission to make independent
enquiries regarding the financial track record of theapplicantand the additional required Information)

PART II

11. NAME AND ADDRESS OF THE PROPOSED MEDICALCOLLEGE (Also upload Certified
copy of the essentiality certificate issued by the respective State Government/Union
territoryAdministrationand Certificate issued by Competent authority of State regarding the land use)
Essentiality Certificate issued date (Calendar)

12. MARKET SURVEY AND ENVIRONMENTALANALYSIS (upload separately the information as

required below)

(a) Give the main features of the state medical educationpolicy.

(b) Availability of trained medical manpower in the state and need for increase in the
provision of medicalmanpower
(c) Gap analysis and how the gap will bereduced.
(d) Catchment area in terms of patients for the proposed medicalcollege/hospital.
(e) No. of hospitals/primary health centres/private clinics available in the catchmentarea.
(f) State how will the existing medical facilities get augmented by the establishment of
proposed medicalcollege.

13. Site characteristics and availability of external linkages. (upload separately the information as
required below; also upload Certified copy of the title deeds of the total available land as proof of
ownership andCertified copy of zoning plans of the available sites indicating their land use)

(a) Topography
(b) Plotsize
(c) Permissible floor spaceindex
(d) Groundcoverage
(e) Buildingheight
(f) Roadaccess
(g) Availability of publictransport
(h) Electricsupply
(i) Watersupply
(j) Sewageconnection
(k) Communicationfacilities

14. Educational program (upload separately the information as required below)

(a) proposed annual intake ofstudents

(b) admissioncriteria
(c) method ofadmission
(d) Reservation/preferential allocation ofseats.
(e) Department wise and year wise curriculum ofstudies.

15. Functionalprogramme(upload separately the information as required below)

(a) Department wise and service wise functionalrequirements

(b) Area distribution and room wise sittingcapacity

16. Equipmentprogramme
Room wise list of Equipment complete withyear wise schedule of quantities and
specifications –
(a) Medical
(b) Scientific
(c) AlliedEquipment
(upload separately the information as required above)

17. Man powerprogramme

Department wise and year wise requirements of –
(a) Teaching staff (fulltime)
(b) Technicalstaff
(c) Administrativestaff
(d) Ancillarystaff
(e) Salarystructure
(f) Recruitmentprocedure
(g) Recruitmentcalendar
(upload separately the information as required above)

18. Buildingprogramme
Building wise built up area of
(a) Medical college(departments, lecture theatre
examination hall, museumetc.)
(b) Faculty and staffhousing
(c) Staff and studentshostels
(d) Administrativeoffice
(e) Library
(f) Auditorium
(g) Mortuary
(h) Cultural and recreationalcentre
(i) Sportcomplex.
(j) Others (state name of thefacility)
(upload separately the information as required above)

19. Planning andlayout

(a) Master plan of the medical collegecomplex
(b) Layout plans,sections
(c) Elevations and floor wise area calculations of
the medical colleges and ancillarybuildings.
(upload separately the information as required above)
20. Phasing andscheduling
Month wise schedule of activities indicating –
(a) Commencement and completion of buildingdesign
(b) Local bodyapprovals
(c) Civilconstruction
(d) Provision of engineering services andequipment
(e) Requirement ofstaff
(f) Phasing ofcommissioning
(upload separately the information as required above)

21. Projectcost
(a) Capital cost ofland
(b) Buildings
(c) Plant and machinery
(d) Medical, scientific and alliedequipment
(e) Furniture andfixtures
(f) Preliminary and preoperativeexpenses
(upload separately the information as required above)

22. Means of financing theproject

(a) Contribution of theapplicant
(b) Grants
(c) Donations
(d) Equity
(e) Term loans
(f) Other sources (ifany)
(upload separately the information as required above)

23. Revenueassumptions
(a) Feestructure
(b) Estimated annual revenue from varioussources
(upload separately the information as required above)

24. Expenditureassumptions
(a) Operatingexpenses
(b) Depreciation
(upload separately the information as required above)

25. Operatingresults
(a) Incomestatement
(b) Cash flowstatement
(c) Projected balance sheets
(upload separately the information as required above)

NOTE:- For Items 14 to18 a comparative statement showing the relevant National Medical
Commission norms vis-à-vis infrastructure/faculty available and/or proposed to be made
available should beuploaded as Annex to Part II).

PART III

26. NAME AND ADDRESS OF THE EXISTINGHOSPITAL(Also upload Proof of

ownership of existing hospital)

27. DETAILS OF THE EXISING HOSIPTALINCLUDING-

(a) Bedstrength
(b) Bed distribution, bed occupancy andwhethera norm of 5 in patients per student would be
fulfilled.
(c) Built up area
(d) Clinical and para clinicaldisciplines
(e) OPDs and OPD attendance department wise
(f) Architectural and layoutplans
(g) List of medical/allied equipments
(h) Capacity and configuration of engineeringservices
(i) Hospital services, administrative services,
other ancillary and support services
(category wise staffstrength)
(upload separately the information as required above)

UPGRADATION AND EXPANSION PROGRAMME:

28. DETAILS ABOUT THE ADDITIONAL LAND FOR EXPANSION OF THE

EXISTINGHOSPITAL

(a) Landparticulars
(b) Distance from the proposed medicalcollege
(c) Plotsize
(d) Authorized landusage
(e) Geography
(f) Soilcondition
(g) Roadaccess
(h) Availability of publictransport
(i) Electricsupply
(j) Watersupply
(k) Sewageconnection
(l) Communicationfacilities
(upload separately the information as required above)

29. UPGRADED MEDICAL PROGRAMME:-

Year wise details of the additional clinical & para clinical disciplines envisaged under
 the expansion programme
(upload separately the information as required above)

30. UPGRADED FUNCTIONALPROGRAMME

(a) Specialty wise and service wise functionalrequirements

(b) Areadistribution
(c) Specialty wise beddistribution
(upload separately the information as required above)

31. BUILDING EXPANSION PROGRAMME:

Year wise additional built-up area to be provided for –

(a) Hospital
(b) Staffhousing
(c) Staff and studentshostels
(d) Other ancillarybuildings
(upload separately the information as required above)

32. PLANNING ANDLAYOUT:

Upgraded master plan of the hospital complex along with –
(a) Layoutplans
(b) Sections
(c) Elevations
(d) Floor wise area calculation of thehospital
(e) Floor wise area calculation of ancillarybuildings
(upload separately the information as required above)

33. DETAILS ABOUT UPGRADATION OR ADDITION IN THE CAPACITY AND

CONFIGURATION OF ENGINEERING SERVICES AND HOSPITAL
SERVICES
(upload separately the information as required above)

34. EQUIPMENTPROGRAMME

Upgraded room wise list of

(a) Medical and alliedequipments
(b) Schedule ofquantities
(c) Specifications
(upload separately the information as required above)

35. UPGRADED MANPOWER PROGRAMME

Category wise distributionof

(a) Medicalstaff
(b) Para-medicalstaff
(c) Otherstaff
 (upload separately the information as required above)

36. PHASING AND SCHEDULING OF THE EXPANSIONOF SCHEME

Month wise schedule of activitiesindicating-
(a) Commencement and completion of buildingdesign
(b) Local bodyapprovals
(c) Civilconstruction
(d) Provision of engineering and hospitalservices
(e) Provision of medical and alliedequipment
(f) Recruitment ofstaff
(upload separately the information as required above)

37. PROJECT COST OF THE EXPANSION SCHEME-

Cost of additional–
(a) Land
(b) Buildings
(c) Engineeringservices
(d) Hospitalservices
(e) Medical and alliedequipment
(f) Furniture andfixtures
(g) Preliminary and pre-operativeexpenses
(upload separately the information as required above)

38. MEANS OF FINANCING THE PROJECT-

(a) Contribution of theapplicant

(b) Grants
(c) Donations
(d) Equity
(e) Term loans
(f) Other sources, ifany.
(upload separately the information as required above)

39. REVENUE ASSUMPTIONS:

Income from -
(a) Various procedures andservices
(b) Upgraded serviceloads
(c) Othersources
(upload separately the information as required above)

40. EXPENDITUREASSUMPTIONS:

(a) Operatingexpenses
(b) Financialexpenses
 (c) Depreciation
(upload separately the information as required above)

41. OPERATING RESULTS

(a) Incomestatements
(b) Cash flowstatements
(c) Balancesheet
(upload separately the information as required above)

42. Certificate signed by the Applicant that the information provided is correct and
true(also to be uploaded)
43. Payment section

44. Management (person/trust) running other medical colleges institutions with address.

Address 1
Address 2
Address 3