TERNA PUBLIC CHARITABLE TRUST’S
TERNA MEDICAL COLLEGE & HOSPITAL
Sector –12, Phase –II, Nerul (W), Navi Mumbai – 400 706,Maharashtra ,India
Ph.+ 022-27720563/ 27723664 / 27721442 Fax + 022- 27716314
E-mail : website:-ternamedical.org
List of the Documents to be submitted
At the Time of Admission for the Academic Year 2016-17
Please submit 1 Original Set + 3 Sets of Attested Xerox Copies of each Document in the following sequence:-
1. Indian Nationality Certificate
2. Domicile Certificate
3. SSC Mark Sheet & Passing Certificate
4. HSC Mark Sheet & Passing Certificate
5. Neet CET 2016 Mark-sheet & NEET selection Letter
6. Medical Fitness Certificate ( as per NEET-UG-2016 Preference Book )
7. Gap Certificate
8. Caste Certificate, Caste Validity Certificate, Non-Creamy Layer (Applicable for
reserved category students)
9. Migration Certificate
10. Transfer certificate/ Leaving certificate
11. Birth Certificate
12. Undertaking on Rs. 100/- stamp paper duly signed before the Notary for
yearly payment of fees on due date
13. Undertaking for Anti ragging activity on Rs.100 stamp paper duly signed
before the Notary .
14. Character Certificate issued by the Principal of last school / junior College
attended mentioning the status of his/her behavioural pattern specially in
terms as to whether he /she has displayed persistent violent or aggressive
behaviour or any desire to harm others. (As per provision made in clause 4
of Anti Ragging Rules /Act.)
14. 4 Passport size Photographs.
Note :- 1. No admission will be done in absence of any applicable required certificate .
TERNA PUBLIC CHARITABLE TRUST’S
TERNA MEDICAL COLLEGE & HOSPITAL
Sector –12, Phase –II, Nerul (W), Navi Mumbai – 400 706,Maharashtra ,India
Ph.+ 022-27720563/ 27723664 / 27721442 Fax + 022- 27716314
E-mail : website:-ternamedical.org
Fees Details
Ist year MBBS Admission-2016-17
1. Ist Year MBBS fees - Rs. 4,62,000/- OPEN
- Rs.2,48,111 /- OBC
- Rs. 34,222/- SC,ST,VJ,NT
*The fee prescribed above is subject to change by Shikshan Shulk Samiti. Therefore the students will have to pay the difference of fees fixed by Shikshan Shulk Samiti.
(To be paid by D.D.in favour of Dean, Terna Medical College, Nerul , Navi Mumbai)
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2. Caution Money Deposit - Rs. 10,000/-
(To be paid by D.D.in favour of Dean, Terna Medical College, Nerul , Navi Mumbai)
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3. MUHS University fees (Sport, Welfare fund & Development) - Rs.350/-
(To be paid in Cash)
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4 . Amartya Shiksha Yojana Insurance Scheme - Rs. 2020/-
(To be paid by D.D. in favour of “ National Insurance Co. Ltd.Payable at Kolhapur.”)
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5. Hostel Fees (fees 50000 + Deposit 10000):- Rs. 60000/-
(To be paid by DD in favour of Terna Public Charitable Trust,Nerul,Navi Mumbai)
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6. Undertaking for fees on Rs.100 Stamp Paper duly signed before the Notary.
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7. Undertaking for Anti ragging activity on Rs.100 stamp paper duly signed before the
Notary (As per clause No.4 of the Undertaking Character Certificate should be
submitted from previous college along with the Undertaking. )
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8.MUHS Eligibility Fee to be paid in cash
OPEN Candidate MUHS elgibility fee Rs.7150/- cash
OBC ,SC,VJ,ST,NT1,NT2,NT3 MUHS eligibility fee Rs. 2200/- cash
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PROFORMA (Undertaking)
Undertaking by student
On stamp paper of Rs.100/-
UNDERTAKING
I,______S/o ______of Mumbai, Indian Inhabitant, residing at ______do solemnly affirm and state as under:
1. I say that I have appeared for the NEET 2016 examination to secure admission in the academic year 2016-17 in Medical/Dental Colleges.
2. I say that solely on the basis of merit I have been admitted to the Terna Medical College in 1st year MBBS Course for academic year 2016-17.
3 I say that at the time of obtaining my admission I have paid a sum of Rs.462000/- as fees for 1st year MBBS Course.
4. I say that I am fully aware that the aforesaid fees paid by me are interim fees and
are subject to revision at any time. In the event of the fees being increased by the
Shikshan Shulka Samiti or Judicial Pronouncement, I hereby undertake to pay the
amount of difference of the fees within a period of 7 days from being notified.
Solemnly affirmed at Mumbai
This _____day of ______2016 Before Me
[ Identified by me:______
NOTARY
ANNEXURE “K”
Proforma (Undertaking)
Undertaking by student seeking admission
(Rs.100 Stamp paper)
UNDERTAKING
Name of Student :
Roll No. :
Year of Study :
Hostel Room no. (if any)
I______S/O ______of Mumbai, Indian inhabitant residing at (Permanent address) ______do solemnly affirm and state as under :
1. I have a local guardian Shri ______residing at ______phone no.______, who can be contacted if required.
2. I say that solely on the basis of merit I have been admitted to the______college in Ist Year ______course in the year ______.
3. I say that I have read the relevant instructions and guidelines / rules against ragging and consequences of indulging in ragging as well as the punishments under the rules of the ragging issued by the competent authorities from time to time.
4. I am submitting herewith a character certificate from my College (specify Name of College last attended)______mentioning the status of my behavioural pattern specifically in terms as to whether I have displayed persistant violent or aggressive behaviour or any desire to harm others.
5. I, the parent / guardian of the student, say that I have gone through the relevant instructions/regulations against ragging as well as punishments and that if my ward has been found guilty, he / she shall be proceeded against, shall be prosecuted.
6. I have taken / not taken the admission in the college hostel and I will be abide by the rules and regulations of hostel and as well as anti ragging rules issued from time to time by government, court and college authorities.
7. Some of the relevant Provisions of ragging and Punishment to be awarded are furnished below :-
All students are informed that RAGGING in educational institution have been prohibited by Maharashtra Government under the Maharashtra Prohibition of Ragging Act, of 1999. Any student or group of students, doing any act which causes or is likely to cause physical or psychological harm or raise apprehension or shame or embarrassment to a student in the college, will be convicted. It includes teasing , abusing, threatening or playing practical jokes or causing hurt to such student or group of student or (ii) asking a student to do any act or perform something which such student will not in ordinary course willing to do.
Any student directly or indirectly commits / participates in, abets or propagates, ragging within or outside the college premises shall, on conviction, BE PUNISHED WITH IMPRISONMENT FOR A TERM EXTENDED TO TWO YEARS AND SHALL ALSO BE LIABLE TO FINE WHICH MAY EXTEND TO Rs.10000/-.
ANY STUDENT CONVICTED OF AN OFFENCE UNDER SECTION 4 (RAGGING) BE DISMISSED FROM THE COLLEGE AND SUCH STUDENT SHALL NOT BE ADMITTED IN ANY OTHER INSTITUTION FOR A PERIOD OF 5 YEARS from the date of dismissal order.
Name & Signature of Parent Signature of Candidate
1. Local Address
(In case of outside students staying
independently by hiring room/ private hostel, Dhramshala etc.)
TERNA PUBLIC CHARITABLE TRUST’S
TERNA MEDICAL COLLEGE & HOSPITAL
Sector –12, Phase –II, Nerul (W), Navi Mumbai – 400 706,Maharashtra ,India
Ph.+ 9122-27720563/ 27723664 / 27721442 Fax + 9122- 27716314
E-mail : website:-ternamedical.org
Academic Year - 2016-17
Whichever is applicable) a) NEET Exam2016 Merit List
b) Vacancy Round
c) NRI / Against NRI
A – PERSONAL INFORMATION OF CANDIDATE
1. Name of the Applicant (in block letters)as given in the qualifying examination
certificate. Surname should be underlined
2. Permanent Home Address (Native place)
Tel. No. With STD CODE Email ID
3 Present address for Correspondence
Telephone No. (Inform the Principal immediately of
Any change in the Address & Telephone No.)
4. Date of Birth
5. Nationality of the Candidate
6. Sex / Male/Female
7. Religion
8. Caste
9. Do you belong to
SC/ST/VJ/ NT1/N2/N3/OBC /OPEN
(A certificate as a proof is essential)
10. Aadhar Card No.
11. Marital Status / Married/Unmarried
B – PERSONAL
INFORMATION OF PARENT/GUARDIAN
1. Father's Name2. Mother's Name
3. Guardian (if parents are not alive) / a) Name:
b) Relationship:
4. Address of Parent /Guardian and Telephone No. & Email-
ID, if any
5. Educational Qualification of Parents / a) Father:
b) Mother:
6. Occupation of Parent with Designation
7. Annual Income of Parent/Guardian from all sources
C – ACADEMIC DETAILS 99
A) Name of School where HSC is completedName of Board for HSC
Year of Passing
HSC Marks & NEET CET 2016 Marks
Subject / XII th marks / NEET CET 2016 / XIIth
i) PHYSICS / English Marks -
ii) CHEMISTRY
iii) BIOLOGY
TOTAL
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Signature of Student Signature of Parent
D – DOCUMENTS OF CANDIDATE
1. Documents to be submitted by the candidate
a) Admission form duly filled in
/ Yes/Nob) Indian Nationality Certificate/ Domicile Certificate / Yes/No
c) SSC Mark Sheet & Passing Certificate
/ Yes/Nod) HSC Mark Sheet & Passing Certificate / Yes/No
e ) NEET Exam 2016 Marksheet
/ Yes/Nof) Leaving/Transfer/Migration Certificate
/ Yes/Nog) Migration Certificate / Yes/No
h) Medical Fitness Certificate
(As per NEET Brochure ) / Yes/No
i) Gap Certificate, if any / Yes/No
j) Caste Certificate ,Caste Validity Certificate ,Non-Creamy Layer
(Applicable for reserved category students) / Yes/No
k) Birth Certificate / Yes/No
l) Undertaking for fees on Rs.100 Stamp Paper duly signed before
the Notary / Yes/No
m) Undertaking for Anti ragging activity on Rs.100 stamp paper duly
signed before the Notary / Yes/No
n) Character Certificate issued by the Principal of last school/junior college
attended mentioning the status of his/her behavioural pattern specially
in terms as to whether he/she has displayed persistent violent or aggressive behaviour or any desire to harm others.(As per provision made in clause 4 of Anti Ragging Rules/Act.) / Yes/No
o) 4 Passport size Photographs.
/ Yes/No
E– Declaration to be signed by the Student & Parent
/1. I have not been debarred from appearing at any examination held by any Government constituted or statutory examination authority in India.
2. I fully understand that the allotment of a course will be made to me depending on my inter se merit, order of Preference given by me and the number of seats available at that point of time.
3. I understand that no documents after last date of submission will be entertained for the purpose of claims or concessions etc. in connection with my admission unless otherwise mentioned in the rules.
- I am fully aware that the Competent Authority or its representative will not make any correspondence with me regarding admission. I am also aware that it is entirely my responsibility to see the notification in the newspaper and the notices on the notice board of the college / website.
- I am aware that any rule imposed by the university such as imposing limits on the number of attempts permissible to pass any examination shall be binding on me.
- I hereby agree to confirm to any Rules, Acts and Laws enforced by Government and I hereby undertake that, I will do nothing either inside or outside the college which may result in disciplinary action against me under these rules, acts and laws referred to.
- I fully understand that the Principal of the college, has a right to expel me from the college for any infringement of the rules of conducts and discipline prescribed by the college or University or Government and the undertaking given above.
- Condition of minimum attendance: I am fully aware that, I will not be allowed to appear for the examination if I do not attend minimum 75 % classes of theory, Practical, drawing etc. I am also aware that I will not be allowed to appear for the examination, if I fail to submit satisfactorily all the assignments, jobs, journals, drawing, reports as specified by the university within stipulated time limit.
- I hereby agree to pay the prescribed fees (inciuding Repeaters Fees) by due date every year till completion of my studies . I also agree that I will not be admitted to the next year nor I will be permitted to fill the Examination Form if I fail to pay the tution fee by due date.
- I shall keep the Attendance in the morning assembly/period meant for Student activities Co-Ordination committee /Sports/ Any function / activities organized by the College as part of my curricular activities and will attend the same.
- I have read and understood the above clauses and hereby append my signature by my own free will.
- I further agree to submit to any action may entail cancellation of admission rustication / expulsion and/or criminal prosecution (if necessary as per law)
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Signature of Parent Signature of the Student Dean
Place :-______Date:-______
TERNA PUBLIC CHARITABLE TRUST’S
TERNA MEDICAL COLLEGE & HOSPITAL
Sector –12, Phase –II, Nerul (W), Navi Mumbai – 400 706,Maharashtra ,India
Ph.+ 022-27720563/ 27723664 / 27721442 Fax + 022- 27716314
E-mail : website:-ternamedical.org
Date:- / /
Submission of the original & xerox documents - Ist MBBS 2016.
Name of the Student :- ______
Address :-______
______Mob.no.______
To,
The Dean
Terna Medical College
Respected Madam /Sir
I the undersigned Mr./Miss______hereby gives you letter
regarding following documents submitted in original & Xerox
a) Admission form duly filled in
/ Yes/Nob) Indian Nationality Certificate/ Domicile Certificate / Yes/No
d) SSC Mark Sheet & Passing Certificate
/ Yes/Nod) HSC Mark Sheet & Passing Certificate / Yes/No
e ) NEET 2016 Marksheet
/ Yes/Nof) Leaving/Transfer/Migration Certificate
/ Yes/Nog) Migration Certificate / Yes/No
h) Medical Fitness Certificate / Yes/No
i) Self student Gap Certificate, if any / Yes/No
j) Caste Certificate ,Caste Validity Certificate ,Non-Creamylayer issued by appropriate
authorities of the Govt of Maharashtra where applicable