Professional Documents
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Dr. R.VENKATESWARLU PROFESSOR001
Dr. R.VENKATESWARLU PROFESSOR001
Assessor's name
ofth. Dean to ensure that rhe lubmitted Declaration form is ONLY ofa Faculty member$hois -tim€
Notc: It islhc r€sponsibility
cmployre has notlppeared for as!,essment rn anyother.ollege for any discipline and in any capacity during the stated ocadem
a. Appointment order: Certifie d copy oforder at this insti tute attached: :lCs / Nci "-
ANDHEA PtrNNE SH, INDIA.
b. Department: fqr',-t*.ar',.uh.,,r
T
c. College/lnstitut E: NARAYANAMEDICALCOLLEGE
d. City / District: ar*r-
e. Appointment: (i) Rqsdi4r/ContractuaUAd-hoc basis
(ii) Fuly'tirne /Part time
(ii9 Wirt Private practice / With# Private practice
t Date of appearance i4 last MCI/NM C assessment:
i. UG , 96 / Any rrther:
ii. Name of College:
iii. Whetlrer appeared and accepted at the same College: yA t tlo ,
iv. Whether appeared and accepted for the same designation: Y/s / No
v. Whether retired fi om Government Medical College: Yes ,DiZo
vi. Ifyes. designation at the time ofretirement:
5. Complete Residential Address ollthe employee:
a. Present: . ,ur t tla )zrL
P.r.^'lln Nol-lfir-
b. Permanent: :q 1t t^r'
-Nq\-r
rse}l5]<--
6. Copy of Proof of Residence suhrnitted and original verified: Yes/No
(Only copies of Pas sportl Aadhar &'voter lD/PassporL/Electricity bilVlandline Phone bill will be considered)
7. Contact details:
a. Oftice telephone with STD code: o86l- .l3l +q a3,Gt1
b. Residence telephone with STD code:
a. MDQ$aubject:
b. DM/lvICh subject:
c. PhD subject:
Note: For PG & Post PG qualifications, particulars ofRegistration of Atlditional Qualificationcertificates
are to be fumished for them to be accepted. Strike out whichcver section is not applicable.
qualifications:
^f
12. Copies ofeducational
a. Copies of MEBS & PG Degree certificates venfied and attached: YEI-No
b. Copies oJ-MBd& ffd-ffie
Registration veritied and attached: y#l No
13. Details ofTeaching experiEfrEE till date:
Professor
l3Se
laiou2ryo- Me.U.J
0dicg^'Ai,.\
Coll-a?f , Nttlorr te'\t'oB 'Tiu(>h G11
14. Have you been considered in U(i/l'G, MCIAIMC inspection at any other medical college in
a teaching or administrative capacity during last 3 years. Ifyes, please give details:
a. Name of College/lnstitution _
l. April 2020
;boc a ls*aa
2. Mav 2020
fi1oo l)J) o
3. June 2020
(-A oo O ls-to o
4. ldy2020 e, -lo a l.)>lo
5. August 2020
Snloo llsto
6. September 2020
{L ooo I YeOo
7. October2020
o,: llsD o
-9-.))
8. Novernber 2020
\-'6 oo o /rt@
9. December 2020
-S-?l o o lrsoa
10. January 2021
l2o ao o 3Loo o
l. February
I 2021
l2a ssa 3l,eo
12- March 2021
/l@o 3@d
[Copy ofPAN card & Form l6(downloaded from I'RACES) for FY 2019-20 (Assessmcnt Ycar 2020-21)to berttach€dl
DECLARATION
Date:
Place: !el-[dlo R.
(Signature of the Facultl,)
ENDORSEMENT
This endorsement is the certification that the undersigned has satisfied herselflhimsell
about the correctness, authenticity and veracity of the content of this declaration lomr in its
entirety and endorsed the above declaration as true and correct. I have personally verificd
all the certificates/documcnts submitted by the teaching faculty with the original
certificates and documents that were submilted by her/him to the Institute and
confirmed the same with the concerned Institule and have found them to be corrcct
and authentic.
Date:
Place: A,at\di"
Signature ( Instit
witJtarfrftfiUl fEolcA LCO Slbr
?ALEM.
A,P. { lA) CHINTH AREOOV
NELLORE.524 NELL oFE 52.1003
ANDHRA PRaOt SH, iH
NMC- Faculty Declaration Form t2021-22)V.1. I
CHECKLIST
SI Documents Submitted
I Recent Passpon size photo of Empltrvcc. Signed by Dean/Principal ofcollege YYslNo
2 Photo tD proof (Go!.1. Authority issucdt: PassporVPAN Card/Voter ID/Aadhar Card rVr I No
Certified copy ofAppoinlnent ordet ,rf the present Institute. r",/l No
4 Proof of Residence: Passport/Voter (lard/Electricity/Landline phone bilU Aadhar Card rdtNo
5 JoiDing report at the preselt institute t/ru No
6 Copies of MBBS, PG, Fhlxegrees rxs applicable) ydrNo
'7
Copies ofMBBS, PG, RbAdegree Rt gistration Certificates (as applicable) y#tuo
8. Copy ofexperience certificates ofall teirching appointments before joining present post. tdl no
9 Relieving order from the previous institutiorl/posting. 'r4 t No
l4 Copy of letter from affiliating University recognizing as PG teacher (for PG assessment) Yes / No
{_.
Signature of Faculty D
NARA
Date:
524 AP,
III) Faculty members must submit tlre levised Declaration form in this format only, Submissions in the
old fonnat will be rejected and Facu lty' rnembers will not be considered as Teaching Faculty.
Gr-TrrT }il-ira Tfiffrq
PARruNNT OF INDI,A
RAPARLA VENKATESWARLU
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ABKPR3825K
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DEAN
NABAYAIIA MEDICAL COTIEGE
, INDIA.
CHINTHAREDDYPALEM,
NELLOFE . 524003.
ANOHRA PRADESH, INDIA.
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I!,5i:5oc:/ Enrollment No. : 102? l10197lOO?23
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o.!6&rASJ INFORMATION
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. Aldhsar l5 prool ol ki6ntity, not ol clti2enshlp.
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NEAF SUNOAT MAEIGI
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It is hereby cer tifled thrt this lg tho €ltry of thc rbove epeclfled nrue ln
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Registorod Medical Ptacllllon?lr should Fcarrrrrr,r'.0,.," no,ffil---:-,^
lheir resirtored oddress end slso to snswsl all I nqu be ae nt to th.m by tha Scglstrlr ln rogard thcrc to
in order lhat thoir correct addrear may b. duly intsrrod ln ths Medlcrl Rcglrtrt.
Alrsr tho publlGation ol lho namo ln lhc p,lntrd Mcdlcll Rcglsta, th! l!3r rdlllon of lhal .tona h th. lsgal
ovidenco ol roghtration.
II
Atl polsons registered under whatovot Diploms ot Diplomm lro loorlly qualilicd fot the pnctlcr ot
Modicino, Su.gory ond Midwifery.
L DEAN
NARAYANA MEDICAL COLI.TGE
CHINTHAREDDYPALEM,
NELLOHE.524OO3.
:,ff{+fiEHffffl" ANDHRA PHADESH, INOIA.
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This is to certi! that the above mentioned doctor having complied with the requirements of
Section-l5C of Andhra Pradesh Medical Practitioners Registration Act, 1968 (as amended Act No.
I 0/2013) and the rules made thereun der his/her registration has been renewed for the period
1 1 1
Vljayawada
Dated: 19 Jul 20'19
6
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(A UNIY OF T. M. A PAI FOUNOATION'
OR.
POST 8OX No.8
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May 06,2010
CERTIFICATE
Duri the above perio4 his work, conduct and character were good.
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0 : 086'l -2317963,64, 68; Fox : 0861 -2317962
E-moil : noroyonomedicol@yohoo'com
ORDER:
PRINCIPAL
TXlNL',trAl
Noroyano Medrcol Lotteg.
ITELLoBE . 624 002
To,
Dr. R.Ven kateswarlu, M.S.,
Associate Professor of Orthopaedics,
Narayana Medical College & Hospital,
Nellore
Copy to:
The Medical Superintendent, NMCH, Nellore
The Coordinator, NMCH, Nellore
The Prof. & HOD, Dept. of Orthopaedics, NMCH, Nellore
The Finance Section, NMCH, Nellore DEAN
NARAYANA MEOICAL COI.LEGF
()tilNTHABEDDypALEttl.
NELLOHE.524OO3.
ANDHRA PRADESH, INDIA,
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TDS R€ronciliation Analysis ard Correctjor Eoabling system
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FORM NO. 16
PART A
Certlflcate under Section 203 of the lDcome-tr! Act, 196l for tar deducted rt source on s.lrry
Nrm. rnd rdalress oflhe Employcr Nrme rnd rddress ofth€ Employec
From To
Tlc Connnissioner oflncomc Tax (TDS)
Roon No. 4l l, lncome Tax Towe$, lG2-3 A.C. Cuard, 2021-22 0l -Apr-2020 3l -Dec-2020
Hyderabad - 5000M
Summrry ofamount prid/credi(ed rod t3x deductcd rt source thercon ln resp€ca ofthe employec
I. DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENIRAL GO}'ERNMf,,NT ACCOUNT THROUGH BOOX ADJUSTMENT
(The deductor to provide payment wise details oftax deductcd and deposited with resp€ct to the deduct€e)
Total (Rs.)
II. DETAILS OF TAX DEDUCTEDAND DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT TIIROUGH CIIALLAN
CIt€ deductor to provide payment wise details oflax deducted and deposiled wit}I respect to the deducte€)
PaSe I of2
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Place NELLORE
I. Pan a (Anrexurc) of the c..tificrte in Form No.l6 shrll b. isued by lhe employer.
of l&r deduclcd ed dep6itld for all the qu.ne6 of thc finmci.l yc.r.
csgs *4.mploy.d wilh €.cb of the.mploye6. P.n B (Amenli.) of&€ crniricar. i! Fom No. 16 may b. isud by €acb oflh..mplry.6 or rh. l$t .nployer a. th€ optim of th. scac-
4. To up&tc PAN &tails in lncoEe Tu D.psrttncrt .lar.b.s., .pply for ?AN .iangc llqu.st' 6rou8h NSDL or UTITSL.
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...ou.t havc becn vsifi€d by Pay & Accounb Officcr (PAO)
Paymml ddaih of TDS / TCS deposited in bank by dcducto. h3vc m.arched wil} det ils mentioned in th. TDS / TCS st rement but the
o smount is ovcr chimcd in lhc st{muL Final (F) €redi! eill bc rcflccr€d only whcn d.ductor rcduccs claimcd mounr i. the srabmerr or
malc. ncw psym.nt for cxces! amount claim.d in rhc 6brcmcnr
RAPURY
Date: 202 l7:04:16
IST
W
DEAN
NARAYANA MEDICAL COLIEGE
CHINTHAFEDDVPALEM,
NELLOiTE t2 ''1',.-1:i
Department ORTITOPAEDICS
ESI NO 0
Designat ion PROFESSOR
PAN NO ABKPR382 5K
Gross salary 120,000.00
Earni.ngs Deductions
120,000.00 36,200.00
cenerated on .: 0910612022
NARAYANA EOUCATIONAL SOCIETY
Department ORTTIOPAEDICS
ESI NO 0
Designatj.on PROFESSOR
PAN NO ABKPR3825K
Gxoss Salarv 120,000.00
Earnings Deduct,ions
120.000.00 36,200.00
Net Pay Rs. Eighty-Three Thousand Eight Hundred only 83,800.00
)
Generated on | 0910612022