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UTTARAKHAND AYURVED UNIVERSITY

HARRAWALA, DEHRADUN

U.A.P.G.M.E.E. - 2016

UTTARAKHAND AYURVEDIC POST GRADUATE MEDICAL ENTRANCE EXAMINATION - 2016

PROSPECTUS

&

APPLICATION FORM

UTTARAKHAND AYURVED UNIVERSITY

HARRAWALA, DEHRADUN

Tel : 0135-2685124 FAX : 0135-2685137

Website: www.uau.ac.in Email : info@uau.ac.in

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Admission Notice For Media

(Uttarakhand Ayurvedic P.G. Medical Entrance Examination-2016)

As per the G.O. of Ayush Education Department, Govt. of Uttarakhand, Uttarakhand Ayurvedic P.G. Medical Entrance Examination-2016 is scheduled to be held on 29th May, 2016 at Dehradun center only. Candidates, who have passed their BAMS examination from any recognized Ayurvedic college in the country, are eligible for the entrance examination. The candidates can download the application forms and submit the required fee of Rs 5000/- (for General and OBC candidates) and Rs. 4000/- (for SC/ST/PH candidates) through online Bank Challan/Bank Draft in favour of Finance Officer, Uttarakhand Ayurved University drawn on Dehradun and get a print out of online application form and send it to Coordinator (UAPGMEE- 2016), Uttarakhand Ayurved University, Harrawala, Dehradun- 248001 with the duly filled application form. The last date of submission of the application forms is 31-03-2016 till 05:00 PM. For more details visit University website: www.uau.ac.in / Helpline No. +917895305763

(Coordinator) U.A.P.G.M.E.E.-2016 Copy to:- for information and necessary action. 1. The Principal Secretary, Ayush Education Department, Govt. of Uttarkhand, Dehradun. 2. P.S. to Hon'ble Vice Chancellor, Uttarakhand Ayurved University, Dehradun. 3. Director, Ayurvedic & Unani Services, Uttrakhand Dehradun. 4. Director Campus, Rishikul Campus (Haridwar), UAU. 5. Principal, Uttaranchal Ayurvedic College, Dehradun. 6. Principal, Hamalayiya Ayurvedic College, Doiwala, Dehradun. 7. Account Officer/ Finance Officer, Uttarakhand Ayurved University, Dehradun. 8. Examination Section. 9. Guard File. (Coordinator) U.A.P.G.M.E.E.-2016

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UTTARAKHAND AYURVED UNIVERSITY

HARRAWALA, DEHRADUN

Uttarakhand Ayurved University was established by the Government of Uttarakhand vide Uttarakhand Ayurved University Act, 2009 for the purpose of ensuring, effective and systematic instructions, teaching, training, research and development in Ayurved. Aim of the Post-Graduate Course: The aim of the course shall be to Impart post graduate level teaching & training to the students and make them competent Ayurved Teachers, Research Workers and specialists in the respective subject.

POST- GRADUATE COURSES OFFERED BY THE UNIVERSITY:

ELIGIBILITY CRITERIA (a) Have passed B.A.M.S. course from any Ayurvedic College recognized by Central

Council of Indian Medicine (CCIM), New Delhi.

(b) Are Registered with any State/Central Council of Indian Medicine (CCIM), New Delhi.

(c) Have completed/will be completing Rotatory Compulsory Internship by 31st October,

2016. DURATION OF THE COURSE: The Course Study for the Post-Graduate Degree of Ayurveda Vachaspati / Dhanvatari -MD/MS(Ayurved) is of three years duration having two Examinations as under: (1) Part-I (Preliminary) Examination at the end of one academic year after admission.

(2) Part-II (Final) Examination at the end of two academic years after completing Part-I Course. The candidate has to submit the Thesis six month before completion of their study

tenure. In case he/she fails to submit the Thesis within the stipulated period, he/she will

not be allowed to appear in the final examination.

1.Kaya Chikista

2. Samhita Sanskrit Evam Siddhant

3. Dravyaguna

4. Sharir Rachana

5. Rasashastra & B.K.

6. Shalya Tantra

7. Panchakarma

8. Swasthavritta

9. Agad Tantra

10. ShalakyaTantra 11. Prasuti & Stri Roga 12. Sharir Kriya

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STIPEND Stipend will be paid to the PG students of Rishikul University campus (Haridwar), as per

Uttarakhand Government rules.

RESERVATION

50% seats are reserved for Uttarakhand State (those who are domicile of Uttarakhand

state and/or passed BAMS from Uttarakhand) & remaining 50% seats for other States. Reservation for Uttarakhand seats will be as per rules of Uttarakhand Government & for

other states seats as per Central Government rules.

UAPGMEE-2016

Downloaded application form

Completed application form should reach the Coordinator (U.A.P.G.M.E.E.—2016),

Uttarakhand Ayurved University, Harrawala, Dehradun by registered post/speed post at

Uttarakhand Ayurved University, Harrawala, Dehradun on or before 5:00 PM latest by

31-03-2016.

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UTTARAKHAND AYURVED UNIVERSITY UTTARAKHAND AYURVEDIC POST GRADUATE MEDICAL ENTRANCE EXAMINATION

(U.A.P.G.M.E.E.-2016)

ADMISSION NOTIFICATION

In compliance to Uttarakhand Ayurved University Statute University will conduct the competitive Entrance Examination on 29-05-2016 for admission to MD/MS(Ayurved) courses in Rishikul Campus (Haridwar) UAU, Uttaranchal Ayurvedic College, Dehradun and Himalayiya Ayurvedic College, Doiwala, Dehradun for the year 2016.

FOR MD/MS (AYURVED) COURSES : The competitive Entrance Examination shall be open to such candidates who:

a) Have passed the BAMS Examination from any Ayurvedic College recognized by Central Council of Indian Medicine (CCIM), New Delhi.

b) Are Registered with any State/Central Council of Indian Medicine (CCIM), New Delhi.

c) Have completed rotatory Compulsory Internship on or before 31st October, 2016.

d) *No of seats in different disciplines and position of reservation is given below. Sr. No. Subject Total

No. of Seats

For Uttarakhand seats

For Other state seats

Rishikul Campus (Haridwar), UAU 1 Ras Shastra evam Bhaishajya

Kalpna 07 02 General

01 SC 01 OBC

02 General 01SC

2 Panchkarma 05 01 General 01 ST

02 General 01 ST

3 Shalya Tantra 05 02 General 01 SC

01 General 01 OBC

4 Dravyaguna 04 02 General

01 General 01 OBC

5 Kayachikitsa 04 01 General 01 OBC

01 General 01 SC

6 Prasuti & Striroga 04 01 General 01 SC

01 General 01 OBC

7 Shalakya Tantra 04 02 General

01 General 01 OBC

Uttaranchal Ayurvedic College, Dehradun 8 Dravyaguna 02 01 OBC

01 General

9 Samhita Sanskrit Evam Siddhant

02 01 General

01 General

10 Swasthavritta 03 01 SC

01 General 01 OBC

11 Agadatantra 03 02 General 01 SC

Himalayiya Ayurvedic College, Doiwala, Dehradun 12 Dravyaguna 03 01 General

01 General 01 SC

13 Kriya Sharir 03 01 General 01 SC

01 OBC

14 Rachana Sharir 03 01 General 01 OBC

01 General

15 Panchkarma 03 01 General 01 General 01 OBC

Total 55 28 27 * Entrance Test for these seats is subject to the approval of C.C.I.M/Government of India.

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EXAMINATION FEE AND LAST DATE OF RECEIPT OF COMPLETED APPLICATION FORM/OMR:-

1- Rs. 5000/- for General and OBC Category 2- Rs. 4000/- for ST/ SC/PH Candidates

a. The candidates will be provided original admit cards by speed post at their respective addresses.

Duplicate admit card can be obtained from respective examination centre a day prior to the fix date of examination as well as one hour before on the date of the examination by depositing Rs.1000/-. Complete details of examination are given in admission brochure and can also be downloaded from University website: www.uau.ac.in.

b. Those candidates, who submit downloaded application forms, have to submit the required fee of Rs. 5000/- only (for General and OBC candidates) and Rs 4000/-only (for SC/ST/PH candidates) through online Bank Challan/Bank Draft In favour of Finance Officer, Uttarakhand Ayurved University drawn on Dehradun and copy of original Bank Challan/Bank Draft will be submitted with the application form. The last date of submission of the application forms to the Coordinator- (U.A.P.G.M.E.E.-2016) Uttarakhand Ayurved University, Harrawala, Dehradun is 31-03-2016 till 5:00 PM by registered/speed post.

c. Duly filled application form will only be accepted along with prescribed examination fee. Those candidates, who are applying through the downloaded application forms, should submit completed application form along with the fee in the form of on line Bank Challan/Bank Draft and send it to Coordinator, UAPGMEE- 2016, Uttarakhand Ayurved University, Harrawala, Dehradun- 248001.

d. Completed application form should reach the Coordinator (U.A.P.G.M.E.E.—2016),

Uttarakhand Ayurved University, Harrawala, Dehradun by registered post/speed post Uttarakhand Ayurved University, Harrawala, Dehradun on or before 5:00 PM latest by 31-03-2016.

(IV) SCHEDULE OF EXAMINATION: (PLEASE SEE SECOND PAGE OF BROCHURE)

Date of availability of online application forms : 25-02-2016

Last date to download application forms : 26-03-2016

Last date of submission of Application form (By Post) : 31-03-2016

Centre of Examination : Dehradun

Date of Examination : 29-05-2016

Date of declaration of tentative result : 31-05-2016

Date of declaration of final result : 10-06-2016

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UTTARAKHAND AYURVEDIC POST GRADUATE MEDICAL ENTRANCE EXAMINATION-2016

(U.A.P.G.M.E.E.-2016)

FOR ADMISSION TO

POST GRADUATE AYURVEDIC DEGREE i.e. MD/MS (Ayurved) IN

RISHIKUL CAMPUS (HARIDWAR), UAU, UTTARANCHAL AYURVEDIC COLLEGE, DEHRADUN

AND HIMALAYIYA AYURVEDIC COLLEGE, DOIWALA, DEHRADUN.

INFORMATION BROCHURE AND ONLINE APPLICATION FORM (Information and Instructions to the candidates and to be retained by the applicant)

1. GENERAL

(i) As per Government of Uttarakhand Ayurved University Statute University will conduct the Competitive Entrance Examination for admission to MD/MS(Ayurved) Ras Shastra Evam Bhaishajya Kalpna, Shalya Tantra, Panchkarma, Samhita Sanskrit Evam Siddhant, Swasthavritta, Dravyaguna, Agadatantra, Prasuti Evam Striroga, Shalakya Tantra, Kayachikitsa, Kriya sharir and Rachana sharir.

(ii) Seats are available in RISHIKUL CAMPUS (HARIDWAR), UAU, UTTARANCHAL AYURVEDIC

COLLEGE, DEHRADUN AND HIMALAYIYA AYURVEDIC COLLEGE DOIWALA, DEHRADUN for the Academic year 2016-17.

(iii) The competitive entrance examination for MD/MS (Ayurved) Ras Shastra Evam Bhaishajya

Kalpna, Shalya Tantra, Panchkarma, Samhita Sanskrit Evam Siddhant, Swasthavritta, Dravyaguna, Agadatantra, Prasuti Avum Striroga, Shalakya, Kayachikitsa, Kriya sharir and Rachana sharir shall be conducted for 55 seats out of which 28 seats shall be filled by those candidates who are domicile of Uttarakhand or Passed BAMS from Uttarakahnd and 27 seats shall be filled by the candidates from other States. These seats of MD/MS (Ayurved) are subject to the permission for admission from CCIM/Govt. of India.

(iv) The eligible candidates who get selected through U.A.P.G.M.E.E. 2016 will be given admission on

available seats in post graduate courses by Counselling on merit cum choice basis.

(v) A candidate who is already admitted to any post graduate course will not be eligible to appear in the U.A.P.G.M.E.E. 2016 till he/she completes the course and passes the examination.

(vi) The Entrance Examination, for admission to all these courses for 2016, will be held on 29-05-2016.

at Dehradun.

(vii) The MD/MS (Ayurved) course shall be of 03 year duration.

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3. ELIGIBILITY CRITERIA For MD/MS (Ayurved) courses Ras Shastra Evam Bhaishajya Kalpna, Shalya Tantra, Panchkarma, Samhita Sansktit Evam Siddhant, Swasthavritta, Dravyaguna Agadatantra, Prasuti evam Striroga Shalakya, Kayachikitsa, Kriya sharir and Rachana sharir :- The competitive Entrance Examination shall be open to such candidates who:-

(a) Have passed B.A.M.S. course from any Ayurvedic College recognized by Central Council of Indian

Medicine (CCIM) New Delhi.

(b) Are Registered with any State/Central Council of Indian Medicine (CCIM) New Delhi.

(c) Have completed/will be completing Rotatory Compulsory Internship by 31st October, 2016.

4. SCOPE OF EXAMINATION, EVALUATION & ELIGIBILITY FOR ADMISSION to MD/MS (AYURVED) :-

(i) The Competitive Entrance Examination for MD/MS (Ayurved) shall consist of one paper of 100 multiple answer questions. It shall be of one and half hours duration and shall carry maximum of 100 marks. Syllabus of the question paper shall be same as course of B.A.M.S. (All Professionals/year).

(ii) All the questions will be objective type with multiple (A,B,C,D) choice of which only one will be the most appropriate response and, therefore, the correct choice. Each answer with correct choice shall be awarded ONE mark. ZERO marks shall be given to no response. 0.25 marks shall be deducted for each wrong response. If more than one choice is indicated against a question it shall be considered as incorrect response and 0.25 marks will be deducted for each such incorrect response.

(iii) Answering Method: Read the instruction of OMR Answer sheet carefully. (iv) Minimum marks criteria: General Category candidates shall have to secure a minimum of 50% marks and the reserved category candidates a minimum of 40% marks in order to qualify for admission to a Post Graduate Ayurvedic course.

(v) Candidates eligible in the reserved category will be given admission as per rules of State Government/

Central Government applicable as on last date fixed for receipt of application. 5. APPLICATION FORM

(i) Online Application forms/brochures will be made available at University website: www.uau.ac.in from 25-02-2016 for download.

(ii) Candidates are required to download Online application form from University website and will have to deposit their fee through online Bank Challan/Bank Draft and send it along with the completed application form to the undersigned.

(iii) A candidate seeking admission through the competitive entrance examination is required to send his/ her application on the prescribed application format, which can be downloaded from the website: www.uau.ac.in completed in all respect to the office of Coordinator (U.A.P.G.M.E.E.-2016), Uttarakhand Ayuerved University, Harrawala, Dehradun- 248001.

(iv) A candidate should not fill in more than one form for the U.A.P.G.M.E.E.-2016.

(v) Before filling up the application form, the candidate must familiarize himself/herself with the information given in this brochure.

(vi) Every detail must be filled in by the candidate. All answer must be given in words and not by dashes or dots. No column should be left blank. Where a column is not applicable, mention “NA”.

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(vii) Incomplete application form and form without examination fee {As explained in para-(ii), (iii)

above} in the form of Bank Challan, shall be rejected.

(viii) Candidate must affix latest passport size photographs in the space provided on the application form. The candidates who have completed their internship can get their photographs attested by a Gazetted Officer. Those who are still pursuing their internship program shall get their photograph attested by the Dean/Principal of their respective institution along with the certificate mentioning expected date of completion of internship, latest by 31st October, 2016. Candidates must bring one passport size photograph and one post card size photograph duly attested by Dean/Principal of their respective institutions in examination hall, failing which photography will be done by authorities at examination centre and Rs. 100/- will be charged for each photograph from the candidates.

(ix) Furnishing of false information or suppression of any information would disqualify the candidate from the competitive entrance examination/admission and cancellation of admission if already admitted. If considered necessary, legal action may also be initiated against such candidate.

(x) Application form of the candidates, who are likely to complete internship on or before 31st October, 2016 for MD/MS (Ayurved) course has to be countersigned by the Dean/Principal of Ayurvedic College from where the candidate has passed the BAMS. Examination in the forwarding note column.

(xi) Candidate employed elsewhere must give a ‘no objection certificate’ signed by the employer for appearing in the entrance examination failing which the application shall be rejected.

6. COMPETITIVE AYURVEDIC POSTGRADUATE MEDICAL ENTRANCE EXAMINATION, 2016: (i) The Postgraduate Ayurvedic Medical Entrance Examination of 2016 will be held on 29-05-2016 at

Dehradun centre. (ii) Admit Card list of eligible/non eligible candidates will be uploaded on University website and admit

card of the eligible candidates will be sent to their respective address by speed post latest by 20th April, 2016. The (Coordinator, UAPGMEE-2016) Uttarakhand Ayurved University, Dehradun shall not be responsible for non-receipt of admit cards due to any reason. Admit Card will not be sent to ineligible candidates and no correspondence in this regard shall be entertained nor shall their fees be refunded. All the fee paid to University is non-refundable.

(iii) However, if due to any reason the candidate fails to receive the Admit Card. The candidates will be given duplicate admit card at their respective examination center by depositing Rs. 1000/- one day before (28.05.2016) and up to one hour before the starting of examination (29.05.2016). Such candidates must bring one attested copy of the same photograph, which he/she affix in the application form. For information regarding examination centre or any other Quarry the candidate can visit University website – www.uau.ac.in.

(iv) Entry to the Examination hall will be restricted to candidates producing the admit card, issued by the

Coordinator (U.A.P.G.M.E.E.-2016), Uttarakhand Ayurved University, Dehradun or Competent Authority of examination Centre.

(v) Examination will be held at Dehradun on 29-05-2016. Details of timing and venue will be

communicated through University website and admit card to the candidates. (vi) Candidates must reach their center at least 30 minutes before the commencement of the examination.

No candidate will be allowed at the examination center 15 minutes after the commencement of the examination.

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7. RESULT AND SELECTION CRITERIA:- (i) Candidates who secure a minimum of 50% marks in case of General Category and 40% marks in case

of Reserved Category (SC/ST/OBC) in the U.A.P.G.M.E.E.-2016 shall be eligible for admission to Post Graduate Ayurvedic Courses subject to availability of the seats through Counselling.

(ii) In case of candidates obtaining equal marks, merit will be determined in order of preference as under:

(a) Candidates scoring less negative marks. If obtained equal marks then,

(b) Candidate obtaining higher average aggregate percentage of marks in all professional exams. If

obtained equal marks then,

(c) According to age i.e. older getting preference over younger.

(iii) Merit list (combined & category wise) of eligible candidates for admission to the Post Graduate Ayurvedic courses shall be declared/published by the Coordinator (U.A.P.G.M.E.E.-2016), Uttarakhand Ayurved University, Harrawala, Dehradun on website www.uau.ac.in and shall be displayed at the Office of the Coordinator (U.A.P.G.M.E.E.- 2016), Uttarakhand Ayurved University, Harrawala, Dehradun.

(iv) The allotment of course to the eligible candidates shall be made by the Counselling Board under chairmanship of Honorable Vice - Chancellor on personal appearance, along with all original documents as per his/her merit and choice of the course. The date and place of Counselling shall be notified through website www.uau.ac.in. No intimation will be sent to the candidate by post. It will be the responsibility of the candidates to check these dates and appear for Counselling and allotment of course. The candidate will have to deposit a fee of Rs. 6,000/- at the time of Counselling thorough online Bank Challan/Bank Draft. All available seats in different courses shall be displayed along with its recognition status at the time of Counselling. The candidate may choose any one of the available seats according to their merit. A seat once allotted to candidate for any course shall be final.

(v) Rs. 30,000/- will have to be deposited by the candidates as advanced tuition fee after allotment of seat. Candidates are allowed to appear for re-counselling only after depositing Rs. 6,000/- Counselling registration fee. Those candidates who failed to take admission after allotment of seat, his/ her advanced tuition fee will be forfeited. Those candidates who wish to withdraw admission, he/she will have to deposit entire course fee, only after that University will issue Migration Certificate. All the fee will be deposited through Bank Challan/Bank Draft.

(vi) University may revise fee (Tuition Fee, Hostel Fee, Exam Fee etc) during the tenure of course which will be applicable with immediate effect and payable by all students of all batches.

(vii) In first Counselling first of all seat of PH candidates will be filled, in case of non availability of sufficient number of PH candidates these seats will be filled by other candidates of same category.

(viii) In last Counselling first of all ST/SC seats will be filled up by interchanging, if further remains vacant than these seats will be filled by OBC category candidates. In case of non availability of sufficient number of OBC category candidates, these seats will be filled by general category candidates

(ix) Students engaged in Anti National Activities /Anti University Activities/Anti Academic Protest etc. will be expelled from the Institute/University and further proceedings will be initiated against him/her as per law.

(x) All the candidate will have to furnish an affidavit on Rs. 100/- non-judicial stamp paper in detail and bank guarantee of Rs. 2.00 lacs at the time of admission.

(xi) Candidates who wish to leave seat after admission because he/she will take admission in other University/Institute will have to deposit Rs. 2.00 lacs other than entire course fee.

(xii) Rules of admission, Entrance Examination, Counselling and Examination will be the same as for UAPMT and vice-versa.

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8. ADMISSION

Admission of the candidates shall be made by the Campus Director /Principal, Rishikul Campus (Haridwar), UAU, Uttaranchal Ayurvedic College, Dehradun and Himalayiya Ayurved College, Doiwala, Dehradun.

(i) A candidate who had qualified for admission to a postgraduate course shall have to deposit the prescribed fee on the date notified for the purpose by the University. Those who fail to do so will loose their claim for admission in the course. Admission in MD/MS(Ayurved) course shall be given only after the candidate produces following original documents at the office of Director Rishikul Campus (Haridwar), UAU, Uttaranchal Ayurvedic College, Dehradun and Himalayiya Ayurved College, Doiwala , Dehradun. (a) High School certificate as proof of date of birth. (b) Original Mark sheets of all professional Examination. (c) B.A.M.S. passing out certificate or degree. (f) Employer’s relieving certificate, if employed. (d) Compulsory Rotatory internship completion certificate. (e) Permanent Registration Certificate of Indian Medicine Board (g) S.C./S.T./O.B.C/PH Certificate, if applicable. (h) Allotment letter, issued by Chairman, Counselling Board of U.A.P.G.M.E.E.-2016. (i) Admit Card of U.A.P.G.M.E.E.-2016. (j) Score Card of U.A.P.G.M.E.E.-2016. (k) Domicile certificate on prescribed Performa.

(ii) Candidates shall be required to complete the admission formalities and join the course assigned to

them within specified period notified by the University. (iii) At the time of Counselling reservation policy will be applicable as per order of the Govt. of

Uttarakhand / Govt. of India.

(iv) After allotment of the seats candidates who failed to join the course within the specified period shall forfeit the right of admission and the security fee.

9. APPLICATION FORM SHALL ACCOMPANY THE FOLLOWING DOCUMENTS: Completed on line Application forms must be accompanied with the checklist provided below.

(a) Attested photocopy of High School pass certificate as proof of date of birth. (b) Attested photocopy of the mark sheets of all the three professional examinations of B.A.M.S. (c) Attested photocopy of the compulsory rotatory internship certificate.

(d) Attested photocopy of provisional/permanent registration Certificate of Indian Medicine Board.

(e) Eligible candidates belonging to reserve category, must submit a certificate on the attached Performa certified by any competent authority. In case the certificate is not as per prescribed Performa the benefit of reservation shall not be allowed.

(f) Attested photocopy of B.A.M.S passing out certificate. (g) Any other certificate. (h) On line Bank Challan/Bank Draft of Rs. 5,000/- ( For General and OBC Candidates) and

Rs. 4,000/- (for SC/ST and PH candidates), along with downloaded application forms. (i) Candidates will submit their domicile Certificate. (j) No Objection Certificate (if employed).

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Page 15 of 18

UTTARAKHAND AYURVED UNIVERSITY

UTTRAKHAND AYURVEDIC POST GRADUATE MEDICAL ENTRANCE EXAMINATION-2016

For Admission to Post Graduate Course MD/MS (Ayurved) APPLICATION FORM

(Incomplete application will not be entertained)

1. Name: ……………………………………………………….…….

(As per High School certificate. Mr./Mrs./Miss./ Dr. not to be included)

2. Father’s Name: ……………………………………………….…

3. Mother’s Name: …………………………………………….……

4. Nationality: ………………………………………………………

5. Date of Birth: …………………………………………….………

(Attach attested photocopy of High School certificate)

6. Place of Birth: …………………………………State ………..………

7. Mark of Identification: ………………………………..…

8. Whether SC/ST/OBC (if yes, attach certificate from competent authority):

9. Full Mailing Address (with pin code for correspondence): ……………………………………..……

………………………………………………………………………………………………………..

……………………………………………………Tel / Mob………………………………………

E-Mail address: …………………………………………………………………………………….

Permanent Address (with Pin Code):

………………………………………………………………………………………………………...

…………………………………………………………………………………………………………

Present Job/Service (if any): ………………………………………………………………………..…

…………………………………………………………………………………………………..…..…

10. School/College Examination passed (attach attested photocopy of mark sheets)

Examination Institution Subjects Year of admission

Year of passing

High School Intermediate/10+2 Any Other

11. Professional Examination passed (attach attested photocopy of mark sheet of all the examination) Class Institution Marks Month and Year

of Passing Maximum Obtained Percentage B.A.M.S. 1st Professional

B.A.M.S. 2nd Professional

B.A.M.S. Final Professional

Grand Total

Affix Photograph duly

attested by Principal of the Institute from

which he/she passed B.A.M.S.

examination/Gazette officer

Signature

LTI in case of Male RTI in case of Female

Page 16 of 18

14. Date of Completion of Compulsory Rotatory Internship (attach attested photocopy) 15. Details of the B.A.M.S. Entrance Examination:-

(a) Name of Entrance Examination:…………………………………..

(b) Year of Entrance Examination: …………………………………..

(c) Conducting body: …………………………………………………

(d) Roll number: ………………………………………………………

16. Registration (attach attested photocopy)

Name of Board/ Council Registration No

17. Mention year-wise account of time gap from completion of internship till submission of application

for U.A.P.G.M.E.E. 2016 From To Details

Course Job Assignment

18. Category (tick applicable) Sub category applicable General ST AFS/WV PH SC OBC FF Women 19. Details of On line Bank challan/Bank Draft Enclosed (with downloaded application forms)

SC/ST/PH Category: Rs. 4000/- General/OBC Category: Rs. 5000/-

(a) Bank Challan No…………………………………………. Date…………………

OR

(b) DD No………….Date……………Issuing Bank……………….Drawn on…………

20. Details of present employment, if any:

Name and full address of the Employer

Post held with date

Nature of appointment

Tenure of appointment (for Temporary employees)

………………………… Date:…………….. Signature of Candidate

Page 17 of 18

DECLARATION BY THE APPLICANT

(a) That I………………………………………………S/D/O ……………………………..resident of (permanent

address)………………………………………………………………………………………………..………..

(b) hereby declare that I am not studying in postgraduate course in any Ayurvedic/Medical College of India. (c) That I hereby declare that the above application has been filled in my own hand-writing and the information

given by me in the application form is correct and nothing has been concealed. In case, at any stage it is found that information furnished by me is false, I shall have no claim to admission and if already admitted, my admission shall be cancelled.

(d) That I further declare that, I shall abide by the rules governing the course as laid down by CCIM/University/ Institution providing the course.

(e) That I am presently not employed/employed with …………………………………… It is further known to me that in case of any dispute the decision of the authorities of the University shall be final and binding on me and shall also submit NOC from employer and competent authority.

(e) That I am domicile of Uttarakhand and/or was admitted in……………………..…………… (College)…………………………………………………………….… (State)……………………………….

(f) That I have not filed any petition in any court of law related to my admission through previous UAPGMEE examination.

(g) That I have filed a petition number…………………………. in……………..………….. Court and I will withdraw my petition, if course is allotted to me on the basis of U.A.P.G.M.E.E. 2016.

(h) I will not involve in any Anti National Activities / Anti University Activities /Anti Academic Protest etc. I know, I will be expelled from the Institute/University.

(i) I will abide by all the rules, regulations and orders of the University.

Signature of Parents/Guardian Signature of Candidate Date:………………….

21 APPLICATION FORM CHECKLISTS:

Completed On line Application forms must be accompanied with the checklist provided below marked(√). (a) Attested photocopy of High School pass certificate as proof of date of birth.

(b) Attested photocopy of the mark sheets of the professional Examinations of B.A.M.S. (c) Attested photocopy of provisional/permanent registration of the Indian Medicine Board.

(d) Attested photocopy of the compulsory rotatory internship certificate.

(e) Eligible candidates belonging to reserve category, must submit a certificate on the attached Performa certified by any competent authority. In case the certificate is not as per prescribed Performa the benefit of Reservation shall not be allowed.

(f) Attested photocopy of B.A.M.S. passing out certificate. (g) Any other certificate.

(h) Original Copy of Online Bank Challan No…………. Dated………….Rs…..………

OR

Bank Draft No………………..Dated……………….Rs.………….…

Payable at………………………………………………………..……..

(i) Domicile Certificate on Prescribed Performa.

(j) No Objection Certificate of employer, if employed. Date: …………….. Signature of Candidate

Page 18 of 18

FORWARDING NOTE BY THE PRINCIPAL

(ONLY FOR THOSE WHO ARE PURSUING INTERNSHIP)

(a) Dr………………………………………….has passed the B.A.M.S examination from this Institution in

academic year ……………………………………………………..

(b) The candidate has already finished his/her compulsory rotatory internship on

dated…………………………. or is expected to complete internship by……………………..

Date: Signature with Seal of the Dean/Principal of the institution

(TO BE FILLED IN BY THE HEAD OF THE DEPARTMENT/EMPLOYER)

ENDORSEMENT BY THE HEAD OF THE DEPARTMENT/EMPLOYER UNDER WHOM THE CANDIDATE IS PRESENTLY WORKING

Dr. ………………………………………………is working under me as ………………………………..for

the last…………. Months/years. To the best of my knowledge, the information furnished by the candidate in

the application form is correct. I have no objection in his/her seeking admission to the MD/MS (Ayurved)

course. If he/she is admitted he/she will be relieved for three years for undergoing the course.

Date: Signature of the Employer With Designation & Seal

(TO BE FILLED IN BY THE HEAD OF THE DEPARTMENT/EMPLOYER)

FORWARDING NOTE TO BE SIGNED BY THE COMPETENT AUTHORITY OF THE ORGANIZATION IN WHICH THE CANDIDATE IS EMPLOYED (IF APPLICABLE)

I certify that this application made by Dr………………………………..S/D/O………………………………..

is being made with my consent and permission and that he/she will be immediately relieved, if selected for the

course.

Signature of the competent authority/Employer

With Designation & Seal