12
SIMS WELCOMES UNDER GRADUATES 2019-20
SIMS WELCOMES
UNDER
GRADUATES
2019-20
INSTRUCTIONS FOR
UNDER
GRADUATE
ADMISSION
2019-20
FOR DETAILED
INFORMATION VISIT
www.mcc.nic.in
&
www.kea.kar.nic.in
FILL UP ALL
THE
DOCUMENTS
IN CAPITAL
LETTERS
ONLY
FOR DETAILED INFORMATION VISIT :
� www.sims-shimoga.com
Shimoga Institute of Medical Sciences, Shivamogga
Instructions for Admission to Under Graduate Courses (Academic Year 2019-20)
Original documents along with Three Sets of Self Attested Photocopies to be submitted in the
following order.
� OFFICE NOTE
� UNDER GRADUATE STUDENT DATA SHEET
� NEET /KEA Allotment Order.
� NEET UG Admit card.
� NEET UG Score card.
� SSLC Marks Card / Birth Certificate.
� II PUC/12th Standard Marks card.
Above said bonds can be downloaded from our college website www.sims-shimoga.com
For all e Stamp papers
For Rural service bond:
� 1st party is the candidate &
� 2nd party is the Director, Directorate of Medical Education, Karnataka
For Anti-ragging Bonds :
� 1st party is the candidate for student declaration & parent for Parent declaration.
� 2nd party is the Director, Shimoga Institute of medical Sciences, Shivamogga
� Study Certificate (Only PUC/12th).
� Transfer Certificate.
� Migration Certificate. (For CBSE/ICSE/AIQ Students)
� Eligibility Certificate issued by RGUHS (For CBSE/ICSE/AIQ Students)
� Caste Certificate. (For candidates claiming Reservation)
� Income Certificate of Parent. (For candidates claiming Reservation)
� Rural Service Bond. (Rs.100/-e stamp paper Duly Notarised) (Format provided to be downloaded)
� Anti Ragging Bonds. (Rs.50/- e stamp paper Duly Notarised) (Format provided to be downloaded)
� Photograph. (5 Pass Port Size and Soft copy in JPG less than 45KB)
� Aadhar card. (Photo copy)
� Physical Disability Certificate. (For differently disabled candidates issued by competent authority )
� Fee Receipt. (To be obtained at the time of admission in the college)
Note: Scan each of the above documents and Name the file accordingly then Save in separate file both in PDF
& JPEG Files (each file should be within 100 to 200kb) create in a single folder with Candidate’s name
in a CD/DVD and also mail to
No.SIMS/UG/ADMN/2019-20 Date:
OFFICE NOTE
Sub: - Admission to Under Graduate Course for the Academic Year 2019-20 – reg.
*****
TO BE FILLED IN CAPITAL LETTERS ONLY
QUOTA AIQ SQ Counseling session( Round) I II III MOP UP
UG NEET ROLL NO. UG NEET SCORE UG NEET PERCENTAGE UG NEET PERCENTILE ALL INDIA RANK STATE RANK RESERVATION QUOTA CLAIMED GM / Cat I / Cat II A / Cat II B / Cat II B / Cat III A / Cat III B / OBC / SC / ST
RESERVATION QUOTA ALLOTTED GM / Cat I / Cat II A / Cat II B / Cat II B / Cat III A / Cat III B / OBC / SC / ST
Mr./Miss. has submitted the following Original certificates.
MOTHER’S NAME Mrs.
FATHER’S NAME Mr.
SL
NO
PARTICULARS
FOR OFFICE USE ONLY
SUBMITTED NOT
SUBMITTED
1. NEET /KEA Allotment Order.
2. NEET UG Admit card.
3. NEET UG Score card.
4. SSLC Marks Card / Birth Certificate.
5. II PUC/12th Standard Marks card.
6. Study Certificate (Only PUC/12
th).
7. Transfer Certificate.
8. Migration Certificate. (For CBSE/ICSE/AIQ Students)
9. Eligibility Certificate issued by RGUHS (For CBSE/ICSE/AIQ Students)
10. Caste Certificate. (For candidates claiming Reservation)
11. Income Certificate of Parent. (For candidates claiming Reservation)
12. Rural Service Bond. (Rs.100/-e stamp paper Duly Notarised) (Format provided to be
13. Anti Ragging Bonds. (Rs.50/- e stamp paper Duly Notarised) (Format provided to be
14. Photograph. (5 Pass Port Size and Soft copy in JPG less than <30KB)
15. Aadhar card (photo copy) No:
16.
Hyderabad karnataka Quota No:
Issued by:
17.
Physical disability Certificate
(for disabled candidates)
No:
Issued by:
18.
Fee Details Bank: Corporation Bank Branch: SIMS, Branch
Fee details paid @college Receipt No Amount :
Paid @ KEA : Receipt No: Amount
Signature of Candidate Signature of Parent/Guardian
Signature of the Scrutinizing Officer
STUDENT DETAILS FOR MBBS COURSE FOR THE ACADEMIC YEAR 2019-20
MBBS 2019-20
AIQ
SQ Counseling session
(Round)
I
II
III
MOP UP
Sl No PARTICULARS TO BE FILLED IN CAPITAL LETTERS ONLY
1 NAME OF THE CANDIDATE
2 GENDER
3 NATIVE PLACE
4 DATE OF BIRTH WITH AGE
5 MOTHER’S NAME
6 FATHER’S NAME
7 FATHER’S OCCUPATION
8 MOTHER’S OCCUPATION
9 PARENTS INCOME PER ANNUM
10 RELIGION
11 CASTE
12 SUB-CASTE
13
PERMANENT ADDRESS
14 PARENT’S MOBILE No.
15 MOBILE No.
16 e MAIL ID
17 AADHAR NUMBER
18 BLOOD GROUP & Rh TYPING
19 INSTITUTION LAST STUDIED
20 HIGHEST EXAMINATION PASSED II PUC/12th Standard
21 REGISTRATION NO.( II PUC/12TH STD)
22 TOTAL MARKS SCORED( II PUC/12TH STD) %
ENGLISH /100 %
23
PHYSICS /100 %
CHEMISTRY /100 %
BIOLOGY /100 %
TOTAL IN PCB /300 %
24 UG NEET ROLL No. UG NEET RANK
UG NEET SCORE UG NEET PERCENTAGE
% UG NEET PERCENTILE
25 TYPE OF ALLOTMENT AIQ / SQ
26 COUNSELING SESSION I Round / II Round / III Round/MOP UP Round
27 AIQ/KEA ADMISSION ORDER NO.& DATE
29 RESERVATION QUOTA CLAIMED GM/ Cat I/ Cat II A/ Cat II B/ Cat II B / Cat III A / Cat III B / OBC/ SC/ ST
30 RESERVATION QUOTA ALLOTTED GM/ Cat I/ Cat II A/ Cat II B/ Cat II B / Cat III A / Cat III B / OBC/ SC/ ST
31 HYDERABAD KARNATAKA QUOTA Yes / No
32 PHYSICAL HANDICAP QUOTA Yes / No
33 DATE OF JOINING THE UG COURSE
34 Fee
Details Bank: Corporation Bank Branch: SIMS, Branch
Fee details paid @college Receipt No Amount
Paid @ KEA : Receipt No: Amount
Place: Shivamogga
Date:
Signature of Candidate Signature of Parent/Guardian
TO BE FILLED IN CAPITAL LETTERS ONLY
DECLARATION
To
The Director,
Shimoga Institute of Medical Seiences,
Shivamogga.
Sir/Madam, MBBS 2019-20
NAME OF THE CANDIDATE
FATHER’S NAME
UG NEET ROLL NO. UG NEET Rank
TYPE OF ALLOTMENT
AIQ / SQ
I Round
II Round
III Round
MOP UP Round
CATEGORY CLAIMED
GM / Cat I / Cat II A / Cat II B / Cat II B / Cat III A / Cat III B / OBC / SC / ST
CATEGORY ALLOTTED
GM / Cat I / Cat II A / Cat II B / Cat II B / Cat III A / Cat III B / OBC / SC / ST
e Mail Mobile No
I S/oD/o _______________________residing at ______________________________________________________
have joined the allotted MBBS seat at Shimoga Institute of Medical Sciences during the Academic year 2019-20 on
_____________ (date) do hereby undertake as follows.
I have submitted all the required Original Certificate at time of admission for the approval of MBBS admission seat.
If found fake or colour xerox i will be held responsible for the same.
Place: Shivamogga
Date:
Signature of Parent/Guardian Signature of Candidate
TO BE FILLED IN CAPITAL LETTERS ONLY
MBBS 2019-20
NAME OF THE CANDIDATE
FATHER’S NAME
UG NEET ROLL NO. UG NEET Rank
TYPE OF ALLOTMENT
AIQ / SQ
I Round
II Round
III Round
MOP UP Round
CATEGORY CLAIMED
GM / Cat I / Cat II A / Cat II B / Cat II B / Cat III A / Cat III B / OBC / SC / ST
CATEGORY ALLOTTED
GM / Cat I / Cat II A / Cat II B / Cat II B / Cat III A / Cat III B / OBC / SC / ST
e Mail Mobile No
NOTARISED BOND TO BE EXECUTED ON A STAMP PAPER OF RS.100/-
FOR CANDIDATES WHO SELECT MBBS SEATS IN GOVERNMENT MEDICAL
COLLEGE OR GOVERNMENT SEATS IN PRIVATE MEDICAL COLLEGES
I S/o/D/o
(hereinafter called the Natural Guardian of the Student) Resident
of on my own volition have joined the allotted MBBS seat at
Shimoga Institute of Medical Seiences during the Academic year 2019-20 on_____________
(date) do hereby undertake as follows.
In accordance with the Amendment to Rule 11 of the Karnataka Selection of Candidates for
admission to MBBS seats in Professional Educational Institutions Rules, 2006, vide Government
Notification–1. No. HFW 79 RGU 2011, dated: 17.07.2012 and amendment act 2017 dated:
06.07.2017 on completion of the course I am prepared to serve in any Primary Health Center or
Primary Health Unit situated in Rural Areas in the State of Karnataka for a Minimum Period of ONE
year and I will abide to rules and regulations of Government of Karnataka.
The above statement is true and correct. My parent and I hereby undertake to act accordingly.
Place: Shivamogga
Date:
Signature of Candidate Signature of Parent/Guardian
Witness
1
Signature
2
Signature
Name Name
Address Address
For all e Stamp papers
� 1st
party is the candidate &
� 2nd
party is the Director, Directorate of Medical Education, Karnataka
ole: It i mandatory 10 ubmit thi affidas it ill th above format, if 011de ir 10 regi terfor theforthcoming academi se sion.
o TH OMMISSI ER
Signature of depon ntSol mnlyaffirm d and sign d in my pr ence on thi the ---------- day of ------------- month .----------- ar aft r reading th cont nt of thi affida it.
rifled at ------------------ place on thi th --------- day of --------- month • -------- year .
RIFI TIrified that the ontent of thi affidavit are rru to the b t of m knowledge and no part of th affida it i fal
and nothing ha be n conceal d or mi tat d therein.
Signature of deponentame: _
Declared thi _day of month of __ ._Jyear.
full nam of tudent \ ith In titut1. _
o dlo Mr.lMr 1M . ----------------------:----=--:----:--:--"7"""been admitted to ..,.---:--,--__ ----:::--:- --:--,-- --:-:_--:- ,rec i d or downloaded a cop of the R gulationEducational In tirutions. 2009, h r inafter called thpro i ion contained in the aid Regulation.I I ha e. in parti ular, p m ed clau e 3 ofth R gulations and am awar a to what constitutes ragging.2 I hav al o. in parti ular. p ru ed lau e 7 and clau 9.1 of the Regulation and am fully aware of thep nal and admini trati e action that i liabl to be taken against me in ca e I am found guilty of or ab ttingragging. acti el or pa i ely. or bing part of a conspira to promote ragging.) I h r by 01 mol a rand und rtak that
a I will not indulge in an behaviour or a t that may be con tituted a ragging und r c1au e of theRegulations.b I will not participat in or ab t or propagat through any act of commi ion or omi ion that may bconstituted a ragging und r c1au of the Regulation .4) I hereb affirm that. if found guilt of ragging. I am liable for puni hm nt ac ording to clau e 9.1 of theRegulations, \ ith ut prejudi e to any other criminal action that may be taken again t me under any p nal lav orany law for the tim being in forc .5) I h r by declar that I ha not b en expelled or d barred from adrni ion in any in titution in the countryon account of being found guilt of, ab rting or bing part of a onspira to pro mot . ragging: and furth r affirmthat. in ca e the d laration i found to be untru . I am aware that m admi ion i liable to be cancell d.
long \ ith th abo em ntion d point I do h reby declar thata I will bey the ode of ondu t fth institute and do not indulge in any kind of in-di iplined a ti ity
\ hile in and off th institution campu .b. I will b olel respon ible for an kind of acciden mi hap cau ed on account of the above m ntioned
c1au e (6.a .
ANNEXURE IAFFIDAVIT BY THE STUDENT
ERTHote: It i mandatory 10 ubmit thi affidavit ill til abov formal, ifyou d. ir to r g; terfor tile
J0I111 omin a ad mic e ;011.
I mnlyaffirm d and ign d in my pr n n thi th da of _ear aft r reading the cont nt of thi affidavit.
rifi d at pia on thi th day of month , year
affidavit i fat
bil
arne:ddr
T I phonTIOt of my knov ledge and no part of thrified that th ont nt of thi affida it ar
and n thing ha been nceal d r mi tat d th rein.
acti ity \ hil in and off the in titution campti .b y '<ard \ ill b olely r ponsibl f r an kind of accid n mi hap cau ed on ac unt f th ab e
m ntioned lau .a .D lared thi day of month f year.
n t indulg in any kind f in-di iplin d
ANNEXURE IIAFFIDAVIT BY PARENT/GUARDIAN
I, rJ r J fullnam of paren guardianb en admitted t
py of th R gulation on urbing th ena of Ragging in High r Edu ati nal In titution , 2h reinafter ailed th "R gulations" . car fully read and fully under t od the pr vi ions contain d in thR gulation .I 1 ha e, in particular, peru d lau of the R gulation and am a'<ar a to what constitut ragging.2 I hav al 0, in parti ular. p ru ed lau 7 and lau e 9.1 of th R gulations and am fully aware of thp nal and admini trati a tion that i liabl to b taken against my ward in a h h i f und guilty of orab tting ragging. a ti ely or pa ively. r bing part of a n piracy to prom te ragging.
1 h reby 01 mnlya rand und rtak thata My ward will not indulg in an b ha iour rat that may b onstituted a ragging und r lau of thRegulati n .b y \ ard will not participat in r ab t r pr pagat through any a t of ommi ion r mi i n that may bcon titut d a ragging und r clau ofth R gulation .
1 h r by affirm that. if found guilty of ragging. my \ ard i liabl for puni hm nt a c rding to lau .1f the Regulation, with ut pr judice to any th r riminal action that may b taken against III v ard under any
p nal lav r any law for the tim being in for e.5 1h reby d lar that my ward ha n t be n xp lied or d barred fr m admi ion in any in titution in the
untry on a ount of bing [I und guilty of. ab tting or bing part of a c n pira y to promote. ragging: andfurth r affirm that, in ca the d laration i found to b untrue, th admi ion of my \ ard i liabl to becan ell d.
UNDER GRADUATE
FEE DETAILS-2019-20
AIQ STUDENTS Rs.67,850 SQ STUDENTS
GM / Cat I / Cat II A / Cat II B /
Cat II B / Cat III A / Cat III B / OBC Rs.67,850
SC/ ST Rs.17,850
MODE OF PAYMENT THROUGH COLLEGE CHALLEN
OR
DEMAND DRAFT
IN FAVOUR OF THE DIRECTOR
SHIMOGA INSTITUTE OF MEDICAL SCIENCES,
SHIVAMOGGA
CHANGES IN THE FEE STRUCTURE WILL BE APPLICABLE FROM
TIME TO TIME AS PER THE ORDERS OF THE GOVERNMENT OF
KARNATAKA.
UNDER GRADUATE ADMISSION PROCESS 2019-20
ADMISSION TIMINGS : 10: 30 TO 5 :00 PM
(Note: Bank transaction closes at 3:30 PM on week days.) VENUE: GROUND FLOOR, ADMINISTRATIVE BLOCK, SIMS, SHIVAMOGGA
PREREQUISITES:
� All the forms and declarations to be downloaded from website.
� Forms to be filled in capital letters and signed.
� Required bonds should be prepared on e-stamp paper, signed, and notarized.
� All original documents to be arranged in the sequence mentioned in INSTRUCTIONS
SHEET � If they are in files /folders, remove them and keep them readily available for verification.
� Three sets of self attested photocopies of all the documents to be kept ready and
arranged in the same order. [
SEQUENCE OF EVENTS
STEP-1
REGISTRATION
Candidate to register at the desk
Collect the token
STEP-2 Document
Verification and
Submission
Original documents and photocopies to be
submitted to verification officer
STEP-3
Fee Challan
Collection and Fee
Remittance
Collect a triplicate challan at accounts desk
Remit the fee at Corporation bank,
SIMS, Campus.
Collect candidate copy of the challan
Submit college copy to verification
officer.
STEP-4
Report Back To
Admission Office
Submit fee challan copy:
� Upload details of candidate online at
the computer desk
� Ledger entry of student’s data(Assisted by Data entry operator) Collect Admission order and
� Acknowledgement
� Return the Token
