Maharashtra University Of Health Sciences, Nashik

 

APPLICATION FORM FOR TRANSFER OF INTERNSHIP

 

Application for transfer for doing Internship Training Programme of B.A.M.S course, from one approved / recognised Ayurved College to another approved / recognised Ayurved College affiliated to Maharashtra University of Health Sciences, Nashik or to another approved / recognized Ayurved college affiliated to other University (Please use capital letters to fill the form)

1) Name of the Applicant : ______________ _____________ _____________________

SURNAME FIRST NAME MIDDLE NAME

2) Address in full : ________________________________________________________________

______________________________________________________________

3) Date of Birth :

(as entered in the register of DD MM YEAR

the College)

4) Name of Parent /Guardian : __________________ __________________ _________________

SURNAME FIRST NAME MIDDLE NAME

 

 

5) Address in full of Parent/ Guardian : ______________________________________________________________

______________________________________________________________

 

 

6) Tel. No. :____________________ E-mail Address.: _________________________________________

7) Name and address of approved / recognised

College in which studying with E-mail : ______________________________________________________________

______________________________________________________________

 

8) Name and address of approved/ recognised ___________________________________________________________

College to which Transfer is desired

with E-mail ______________________________________________________________

9) Details of Demand Draft : DD No.......................Amount ........... Date......... Name of the Drawee Bank...........................

10) Give the following information :

 

Sr. No.

Name of Exam.

Date & Year of

Passing

Marks obtained

Out of

No. of attempts

Corrected Marks (for office use)

1)

1st BAMS

 

 

 

 

2)

2nd BAMS

 

 

 

 

3)

3rd BAMS

 

 

 

 

 

 

11) Please enclose the following Certificates with your application.

i)                     Ist BAMS Marksheet and Attempt Certificate, ( True Copy)

ii)                   IInd BAMS Marksheet and Attempt Certificate, ( True Copy)

iii)                  IIIrd BAMS Marksheet and Attempt Certificate, ( True Copy)

iv)                  No Objection Certificate from Relieving College (Original)

v)                   No Objection Certificate from Receiving College (Original)

vi)                  Certificate from the Dean/ Principal stating that the present College is approved / recognised by Central Council of Indian Medicines ( Original)

vii)                Demand Draft of Rs. 1000/- towards transfer fee drawn in favour of the Registrar, MUHS, Nashik from Nationalized Bank.

 

12) Grounds for Transfer (if any) : ____________________________________________________________________

(Please attach supporting documents in support of grounds for transfer)

 

13) Declaration:

 

I, hereby declare that the information given above is true to the best of my knowledge and belief.

 

Place :

Date : Signature of Applicant

N. B. : Please write Name and address on backside of Demand Draft.

ANNEXURE 'A'

 

PRESCRIBED FORM FOR NO OBJECTION CERTIFICATE

NAME OF THE RELIEVING COLLEGE : ________________________________________________

 

Subject: Issue of No Objection Certificate to .......................................................

 

Reference: His/Her application dated ....................................................................

 

With reference to the above, I have to state that this College has No Objection for the transfer of Shri/Kum........................................................... from this College to any other approved / recognised College affiliated to M.U.H.S. or to any other College outside the jurisdiction of MUHS for doing Internship Training Programme. This No Objection Certificate is issued on the basis of merit of the case and is within the prescribed permissible limit of transfer quota for the year ........... as per University rule.

 

i) Date of Birth of the Applicant ________________________________________________________

as per the College record,

 

Signature __________________________

 

Name : ___________________________

 

 

Date :- ____________ DEAN/PRINCIPAL

Place:- ____________ Seal of the College

 

 


ANNEXURE 'B'

 

PRESCRIBED FORM FOR NO OBJECTION CERTIFICATE

 

NAME OF THE RECEIVING COLLEGE : _______________________________________________________

 

Subject: Issue of No Objection Certificate to .......................................................

 

Reference: His/Her application dated ....................................................................

With reference to the above, I have to state that this College has No Objection to allow Shri/Kumari.........................................for doing Internship Training Programme in this College against the prescribed limit of the intake capacity. The intake capacity of the College is............

 

 

 

 

Signature __________________________

 

Name : ___________________________

 

 

Date :- ____________ DEAN/PRINCIPAL

Place:- ____________ Seal of the College

------------------------------------------------------------------------------------------------------------------------------------------

(For Office Use)

 

RECEIPT

 

Received application bearing No...................dated..................from Shri/ Kum. ................................................

for transfer for doing Internship Training Programme with the copies of the following documents and fee :

 

i)                     Ist BAMS Examination Mark sheet & Attempt Certificate, (True Copy)

ii)                   IInd BAMS exam. Marksheet and Attempt Certificate, (True Copy)

iii)                  IIInd BAMS exam. Marksheet and Attempt Certificate, (True Copy)

iv)                 No Objection Certificate from Relieving Parent College,

v)                   No Objection Certificate from Receiving/ Admitting College,

vi)                 Certificate from the Dean/Principal stating that the College is approved / recognized by CCIM.

vii)                D.D. for Rs.1000/- towards transfer fee.

viii)              Medical Certificates (If applied on Medical Ground)

 

 

 

Signature of Receiving Officer