Establishment of New Unani College-2014-15 (LOI) Page 34 of 34
PART –I
CENTRAL COUNCIL OF INDIAN MEDICINE
NEW DELHI
VISITATION PROFORMA FOR ASSESSMENT OF AVAILABLE FACILITIES OF TEACHING AND PRACTICAL TRAINING FOR ESTABLISHMENT OF NEW UNANI COLLEGES & ATTACHED HOSPITAL
(For the Session 2014-15 Under Section 13 (A) of IMCC Act 1970)
(To be filled up by the Principal and countersigned by Secretary or President of the Society)
Section ‘A’
I. GENERAL INFORMATION:-
1. / Date of visitation2. / Name of the College with Complete Address with Email ID & Website of College
(Mentioning taluka, dist., Pin code and other details)
3. / Purpose of Visitation
4. / Year of Establishment of Society / Trust
5. / Year of Establishment of College
6. / Name & Address of Managing Society / Trust
7. / Information of President / Secretary of Society/Trust of College (For Private / Private Aided college) / Name & Address
Office Tel. No.
Residence Tel. No.
Mobile No.
Email ID
8. / Contact details of the Society/Trust of College / Contact No. of College
Contact No. of Hospital
Fax
Website
9. / Information of Principal / Name
Office Tel. No.
Residence Tel. No.
Mobile No.
Home Address
Permanent Address
Office Address
10. / Whether Government / Grant-in-aid / Private / Constituent College of University
11. / Information of State Govt. Health Secretary / AYUSH Secretary dealing with the education of Ayurved, Unani and Siddha / Name & Address
Office Tel. No.
Residence Tel. No.
Mobile No.
Email ID
12. / Information of State Govt. Director of Unani / AYUSH / Name & Address
Office Tel. No.
Residence Tel. No.
Mobile No.
Email ID
13. / NOC of State Govt. / Date/Period
14. / Last visitation of State Govt. / Date
15. / Information of University
1. Chancellor (deemed university) /
Vice chancellor / Name
Office Tel. No.
Mobile No.
2. Registrar / Name
Office Tel. No.
Mobile No.
Email ID
16. / Details of consent of affiliation of University. / Name of University
Date & period of affiliation
17. / Last visitation of University / Date
Academic Year
18. / Important information of connectivity / Name of Nearest Airport &
Distance (km) / 1.
2.
3.
Name of Nearest Railway station & Distance (km) / 1.
2.
3.
19. / Fee Structure / Management seats
Government seats
Name of the fee fixation authority
20. / Name of nearest Police Station / Name & Address
Telephone Number
21. / Existing Intake Capacity / Course / Intake
UG
PG (If existing)
II. DETAILS OF LAND
Presently the College, Hospital and Hostels are on its own land or lease, details be furnished as mentioned below.
Details of Land / (As per CCIM Norms in sq.mt.) / Available(up to 60) / (61 to 100)
Total Area of Land (in acres) / 3 Acres / 5 Acres
Total constructed area required for college building for 1st year as per MSR / 660 sq.mt. / 1320 sq.mt.
Total constructed area of hospital building / 2,000 sq.mt. / 3,500 sq.mt.
*Area certificate of layout plan in blue print with details of Departments has been submitted or not …………
Ownership of land if it is in the regional language, then Certified English/Hindi translation duly attested by Gazetted Officer has been submitted or notIn the name of the Society/Trust
In the name of President/Secretary
Whether land is on ownership by registry or lease basis. If on lease basis, then period of lease
Whether entire land is in one plot or more than one. If more than one, then size and distance between these plots*
(Government Authorized Engineer’s certificate to be attached)
Whether the land available with the Society/Trust is entirely for Unani College and attached Hospital or for any other Institute also, if so, details thereof.
III. FINANCIAL INFORMATION (Attested audited Report to be enclosed)
Year / Total income receipt during last three years / Total expenditure receipt of last three years2011-2012
2012-2013
2013-2014
Details of the following to be provided: (from 1st Jan. 2013 to 31st Dec. 2013 and from 1st Jan. 2014 to 31st Aug. 2014)
1. / Salaries of teaching and non teaching Staff2. / Salaries of the Hospital Staff
3. / Non salary expenditure of the college
4. / Non salary expenditure of the Hospital.
Section ‘B’
INFORMATION OF THE COLLEGE
Phase wise specific requirement (as per MSR)
1. ADMINISTRATIVE BLOCK
S.No. / Details / Availability in sq.mt.1. / Total Area in sq.mt. (up to 60 seats - 150 sq. mt. & 61 to 100 seats - 300 sq. mt.)
2. / Office of the Principal
3. / Personal Assistant Room
4. / Reception
5. / Visitors Lounge
6. / Staff Committee Room
7. / Clerk Room
8. / Accounts’ Section
9. / Record Room
10. / Central Store
11. / Separate Toilets for gents and ladies
Total Area
Whether space is available for establishment of 2nd year departments ? / Yes or No
2. KULLIYAT DEPARTMENT
S. No. / Requirement / Availability in sq.mt.1. / Total Required Area of deptt.
50 sq.mt. (up to 60) / 100 sq.mt. (61 to 100)
Departmental Space / Existing Sitting space in sq.mt.
2. / Professor
3. / Reader
4. / Lecturer
5. / Departmental Library cum Tutorial Room
6. / Departmental office
7. / Space for Non Teaching staff
Total Area
3. TASHREEHUL BADAN DEPARTMENT
S. No. / Requirement / Availability1. / Total Required Area of deptt.
125 sq.mt. (up to 60) / 250 sq.mt. (61 to 100)
Departmental Space / Existing Sitting space in sq.mt.
2. / Professor
3. / Reader
4. / Lecturer
5. / Well ventilated Dissection Hall with exhaust fans and preferably air conditioned
6. / A room for students with adequate lockers and washbasins
7. / Embalming Room with Storage Tank or freezer for four dead bodies
8. / Departmental office
9. / Space for Non Teaching staff
10. / Tashreeh ul Badan Museum with optional micro-anatomy laboratory
Total Area
4. MUNAFEUL AZA DEPARTMENT
S. No. / Requirement / Availability1. / Total Required Area of deptt.
75 sq.mt. (up to 60) / 150 sq.mt. (61 to 100)
Departmental Space / Existing Sitting space in sq.mt.
2. / Professor
3. / Reader
4. / Lecturer
5. / Departmental Library cum Tutorial Room
6. / Departmental office
7. / Space for Non Teaching staff
8. / Munafuel Aza (Physiology) laboratory with optional facility for biochemistry testing
Total Area
DETAILS OF REQUIREMENTS OF VARIOUS SECTIONS OF COLLEGE
1. LIBRARY
S. No. / REQUIREMENT / AVAILABILITYTotal Required Area of Library
(100 sq. mt.) for up to 60 intake & (200 sq. mt.) for 61 to 100 intake
1. / Number of Rooms/Halls
Number of books required
(to start new college) :2000
(List of books be enclosed)
a) / Ayurveda
b) / Unani
c) / Siddha
d) / Modern
e) / Others
Total
2. / Journals/Magazines being subscribed Total
Medical
Other
3. / Seating Capacity in reading room
· 50 seats (up to 60 intake)
· 80 seats (up to 61-100 intake )
4. / Working hours
5. / Staff Adequate Staff
a. / Librarian
b. / Asst. Librarian
c. / Library Attendant/Peon
6. / Facilities available in the library
a. / E-library – number of computers with printer and internet facility
b. / Photocopying machine and printer
c. / Separate reading room for Faculty members
2. CLASS ROOMS
Requirement / AvailableLecture Halls : 02
Area :
80 X 2 = 160 sq. mt. (for up to 60 intake)
160 X 2= 320 sq. mt. ( for 61 to 100 intake)
3. HERBAL GARDEN
REQUIREMENT / AVAILABILITY1. / Total Required Area of Herbal Garden
(2500 sq. mt.) for up to 60 intake & (4000 sq. mt.) for 61 to 100 intake
2. / Required number of species of medicinal plants with names : 50
(list to be enclosed)
3. / Staff (List to be enclosed)
(a) Gardener – 1
(b) Multi purpose workers - 2 / (i) ______
(ii) ______
(iii) ______
(iv)
4. OTHER ALLIED INFRASTRUCTURE REQUIREMENTS OF COLLEGE
S.No. / ALLIED INFRASTRUCTURE REQUIREMENTS / AVAILABILITY1. / Hostel Facility
2. / Sports and Games Facility – Available / Not Available
3. / Transport facility – Available / Not Available
IV. STATUS OF TEACHING STAFF REQUIRED FOR 1st YEAR
S.No. / Department / Intake Capacity for UG / Number of Teachers required as per regulation / No. of Existing TeachersP / R / L / P / R / L
(1) / Kulliyat* / Up to 60 / 1 or 1 / 1
61 to 100 / 1 / 1 / 1
(2) / Tashreehul badan / Up to 60 / 1 or 1 / 1
61 to 100 / 1 / 1 / 1
(3) / Munafeul Aza / Up to 60 / 1 or 1 / 1
61 to 100 / 1 / 1 / 1
Total / Up to 60 / 3 / 3
61 to 100 / 3 / 3 / 3
Required * one language teacher on contract basis
Pay Scale of teachers / As per State govt. (Yes/No) / UGC (Yes/No)1. Professor
2. Reader
3. Lecturer
Mode of Payment and Allowances: through Bank / Cash (Enclose Proof)
Whether PF/GPF scheme is existing or not
Number of teachers possessing UG Qualification.
Number of teachers possessing PG Qualification.
V. DETAILS OF TECHNICAL AND OTHER STAFF OF UNANI COLLEGE
S. No. / Department / Post / Requirement / Existing1. / Library / Librarian / 1
Assistant Librarian / 1
Library Attendant or Peon / 1
2. / College office / Clerical Staff for Administrative & Account services / 4
3. / Kulliyat / Attendant / 1
4. / Tashreehul Badan / Laboratory Technician
Museum Keeper
Lifter / 1
-
1
5. / Munafeul Aza / Laboratory Technician
Museum Keeper / 1
-
Note: - (The sweeper, Attendant, Lifter, Laboratory assistant, Data Entry Operator (DEO), Multipurpose worker could be on contractual basis)
LIST OF ANNEXURES TO BE SUBMITTED BY COLLEGE
S.No. / Annexure Number / Name of the Annexure1. / Annexure-I / Proforma to furnish the details of teaching staff appointed/Consent given
2. / Annexure-II / Proforma to furnish the salary details of teaching staff
3. / Annexure-III / Proforma to furnish the details of non- teaching staff
4. / Annexure-IV / Proforma to furnish the salary details of non- teaching staff
5. / Annexure-V / Proforma to furnish the details of hospital staff
6. / Annexure-VI / Proforma to furnish the salary details of hospital staff
7. / Annexure VII / Notarised affidavit to be filled up by the newly appointed teacher in the given format
Signature of Visitors with date Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI) Page 34 of 34
Annexure – I
PROFORMA TO FURNISH THE DETAILS OF TEACHING STAFF APPOINTED/CONSENT
S. No. / Name of the Teacher / Father's Name / Date of Birth / UG Qualification(University & year) / PG Qualification
with subject (University
& year) / Date wise details of Experience in chronological order (1st appointment to till date) / Nature of present appointment (regular/ contractual/ deputation/ part time/ adhoc) / Address / Date of appointment/Consent / Department in which teacher has been appointed/Consent / Name of State Board & Registration Number / Whether the appointment/Consent is in subject concerned or in Allied subject as per CCIM norms / Telephone Number & Mobile Number of Teacher / Photograph of Teacher (Attested by the Principal) / Signature of Teacher (At the time of visitation)
Duration
From - To / Designation / Name of the college / Department
(Subject)
Sur Name / First Name / Middle name
Note: Please attach the following certified copies of the teachers:
a) Consent letter
b) Original Affidavit
c) Under-graduate and Post-graduate degree certificates
d) Registration certificate
e) Proof of date of birth
f) Appointment & Joining letter
g) Experience & relieving certificates
h) Certificate/ Proof of Change of Name ( In case of Change in Name)
Annexure – II
PROFORMA TO FURNISH THE SALARY DETAILS OF TEACHING STAFF
(1) / (2) / (3) / (4) / (5) / (6) / (7) / (8) / (9) / (10)S.No. / Name of teacher / Designation / Pay Scale / Basic Pay / DA & Other allowances / Deduction
GPF /CPF / IT / Gross Pay / Net pay / Contact No.
Annexure – III
PROFORMA TO FURNISH THE DETAILS OF NON- TEACHING STAFF
(1) / (2) / (3) / (4) / (5) / (6) / (7)S. No. / Name of Employee
/ Father’s Name / Qualification / Date of appointment / Designation / Name of Department
Annexure – IV
PROFORMA TO FURNISH THE SALARY DETAILS OF NON- TEACHING STAFF
S.No. / Name of the employee / Designation / Scale of pay / Basic Pay / DA & Other allowances / Deduction / Gross Pay / Net payAnnexure – V
PROFORMA TO FURNISH THE DETAILS OF HOSPITAL STAFF
S. No. / Name of Employee / Father’s Name / Date of Birth / Qualification / Date of appointment / DesignationAnnexure – VI
PROFORMA TO FURNISH THE SALARY DETAILS OF HOSPITAL STAFF
S.No. / Name of the employee / Designation / Scale of pay / Basic Pay / DA & Other allowances / Deduction / Gross Pay / Net paySignature of Visitors with date Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI) Page 34 of 34
Annexure-VII
NOTARISED AFFIDAVIT TO BE FILLED UP BY THE NEWLY APPOINTED/CONSENT
GIVEN BY TEACHER IN THE GIVEN FORMAT
S.No. / Information of Teacher / To be filled up by Teacher
1. / Name of the Teacher (Sur Name- First Name- Middle Name)
2. / Change of Name (if Applicable after marriage)
3. / Date of Birth ( dd / mm / yyyy )
( xx/xx/xxxx)
4. / UG Qualification (University & year) / Year
Name of the University
5. / PG Qualification with subject (University & year) of completion / Subject
Year
Name of the University
6. / Ph.D (if applicable) / Subject
Year
Name of the University
7. / Post wise details of Experience in chronological order (* Date, Month and Year wise experience should be mentioned) / Duration
(dd/mm/yyyy) to (dd/mm/yyyy) / Department (Subject) / Designation / Name of the college
8. / Present working Department (Subject)
9. / Present Designation
10. / Nature of present appointment (regular/contractual/deputation/part time/ adhoc)
11. / Name of present working college
12. / Permanent Residential Address
13. / Local Residential Address
14. / State Board/ Council Registration detail / Registration Number
Name of State Board
15. / Bank detail / Salary Account Number
Name and Branch of Bank
16. / Contact Number / Mobile Number
Residence Number
Permanent Residence Number
Email ID
I hereby solemnly affirm that the above information is correct as per my record and knowledge. I further affirm that if any information given in this affidavit is found to be incorrect/ false, I shall be liable to be blacklisted or debarred from service and to face any disciplinary action.