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P a g e | 1

AFFIDAVIT for PROVISIONAL/ PERMANENT REGISTRATION NUMBER2020-2021

(To be submitted on a Rs. 200 non-Judicial Stamp paper and duly attested

by a 1st class Magistrate, Oath Commissioner or by a Notary Public with

Notarial Stamp of sufficient value AFFIDAVIT [DELETE which one is not

applicable)

1, _____________ son/daughter o f _____________ resident

of______________________do solemnly declare and affirm as

follows:

1. That I am an Indian citizen/(OCI) having successfully completed and

passed my Medical Graduation through regular mode of education (not off

campus /distant mode of education) from the University o f -----------------------

------------ 1 ----------- (University .Country) during the entire period of

recognized course in an approved institution by the Medical council of

India starting from -------------- till------------------- after duly obtaining the

Eligibility Certificate from the authority concerned (strike out the italic

portion if it is not applicable to those applicant who are exempted ) as per

^Eligibility Requirement for taking admission in an undergraduate medical

course in a Fc reign Medical Institution Regulations, 2002”.

2. I affirm that the above University is in the approved list maintained by

the Medical Council of India during the entire period of my course of Study

and passing out abroad and the Course I have undergone is a medical

P a g e | 2

graduation equivalent to MBBS in India as recognized by the Medical

Council of India.

3. I affirm that I have passed the screening test for Foreign Medical

Graduate conducted by the National Board of Examinations as per

Screening tost regulations 2002 in-----------------------------------------------------

-(Month&Year) with Roll No.-------------------------

4. I affirm that I have submitted all relevant documents necessary to prove

my age, eligibility for the course as per as per ‘’Graduate Medical Education

Regulation 19')7” and course of study, pass of examination determining

qualification for applying permanent Registration with Travancore -Cochin

Medical Councils. I had undergone internship in the MCI approved

institution for the prescribed period successfully and completed all the

requirement for Permanent Registration.

5. I affirm that I am well aware about the fact that due to the Pandemic

COVID -19 situation in and around the world , due document verification ,

confirmation from the respective institutions and also the in-person

original dociment verification including passport during the entire course

period , scrutiny committee meeting and its recommendation followed by

the approval of the Modern Medicine Council could not be carried out. I

know that my Permanent registration is subject to the full fillment of ail the

conditions and criteria as laid down by the statues relevant and the

registration number allotted to me can be used for the purpose of

employment in accordance with the law after completing all formalities, the

original Permanent Registration certificate will be issued to me is liable to

P a g e | 3

be cancelled and the registration certificate to be returned in case of any

false or fabricated document or claims made by me or any laxity on my part

to fulfill any condition laid down by the Council upon me, and in such an

event I am bound to accept the same without any further dispute in any

manner.

6. I affirm that all the facts stated above are true and correct to the best of

my knowledge and belief and nothing untrue has been stated not any facts

has been concealed and if anything found contrary to the above, I

understand, I am liable for indemnifying the Travancore-Cochin Medical

Councils to the extent it deem fit and proper and also debar from

registration of the Council permanently.

7. I affirm that I shall abide by all terms and conditions in the proceedings

No.C2-1191/2021/MC/FMG dated 03-05-2021 of TCMC without fail

[DEPONENT)

Witness

1.

2 .

P a g e | 4

Verified this

VERIFICATION

day o f______ year 202_ that the contents of my

above affidavit are true to the best of my knowledge and belief and nothing

untrue has been stated not any facts has been concealed.

f a i c i ] - p £ ^ ^ 0 N € / v ’T L i s ~ f r - i f

ANNEXURE B(6): LIST OF PERMANENT REGISTRATION NUMBERS &REGISTRATION DATE ALLOTTEDTO FOREIGN MEDICAL GRADUATES

(Vide Proceedings No. C2-11191/MC/F dated 03-05-2021, the Permanent Registration Numbers allottedto the applicants)

SL No Name of the applicant University & Country

Registration No Allotted due to

Covid Pandemic Situation

RegistrationDate

1 MENON RAHULPEOPLES FRIENDSHIP UNIVERSITY, RUSSIAN FEDERETION 80927 06-05-2021

2 CELINA THIRUNAVUKKARASUYEREVEN STATE MEDICAL UNIVERSITY, ARMENIA 80928 06-05-2021

3 PEREPPADAN JOHNY BABY0. 0. BOGOMOLETS NATIONAL MEDICAL UNIVERSITY, UKRAINE 80929 06-05-2021

4 JINTO GEORGETBILISI STATE MEDICAL UNIVERSITY, GEORGIA 80930 06-05-2021

5 LASLY VALLILTBILISI STATE MEDICAL UNIVERSITY, GEORGIA 80931 06-05-2021