MAHARASHTRA UNIVERSITY OF HEALTH SCIENCES, NASHIK

APPLICATION FORM FOR TRANSFER

Application for transfer to 2^nd Year Professional Part of course of the Health Sciences, from one recognised College to another recognised College in Health Sciences affiliated to Maharashtra University of Health Sciences, Nashik. (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

the College) DD MM YEAR

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 of Course : __________________________________________________________________

8) Name and address of recognised

College in which studying with E-mail : ____________________________________________________

____________________________________________________

9) Category of seat : Free / Payment

10) Name and address of recognised ______________________________________________________

College to which Transfer is desired

with E-mail ______________________________________________________

11) Give the following information :

S.No.	Name of Exam.	Date & Year of Passing	Marks obtained out of	No. of attempts	Corrected Marks
1)	H.S.C. or its equivalent
2)	Ist Professional Exam.

For corrected marks deduct 5% marks for each attempt from aggregate marks at First Professional Exam. And H.S.C. or its equivalent examinations.

12) Grounds for transfer: _____________________________________________________________

(Please attach supporting documents)

13) Please enclose the following Certificates with your application.

i) XIIth Std. Marksheet & Passing Certificate, ( True Copy)

ii) I^st Professional exam. Marksheet, Passing and Attempt Certificate, ( True Copy)

iii) No Objection Certificate from Relieving College (Original)

iv) No Objection Certificate from Admitting College (Original)

v) Certificate from the Dean/ Principal stating that the present College is recognized by concerned Council ( Original)

vi) Medical Certificate (Certifying the illness causing disability, original)

vii) Admission letter issued by the Competent Authority

viii) Demand Draft of Rs. 500/- from Nationalized Bank drawn in favor of Registrar Maharashtra University of Health Sciences, Nashik.

14) Declaration:

I hereby declare that the facts stated above are true to the best of my knowledge and belief.

Place :

Date : Signature of Applicant

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 recognised College affiliated to M.U.H.S. 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) Position of outstanding dues, if any

iii) Date of Birth of the Applicant

as per the College record,

iv) Category of the applicant :a) All India quota/NRI/CET

b) Payment seat / Free seat

c) Whether belongs to reservation category : Yes / No

If yes, category :SC / ST/ VJ /NT/ OBC.

Signature __________________________

Name : ___________________________

Date DEAN/PRINCIPAL/DIRECTOR

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 transfer Shri/Kumari.………………….......……………………................................. to this College against prescribed limit of the intake capacity. The intake capacity of the College is............ . The breakup of the vacancies is as given below :

Free Seat...................... Payment Seat.....................

Signature __________________________

Name : ___________________________

Date DEAN/PRINCIPAL/DIRECTOR

Place: Seal of the College

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(For Office Use)

RECEIPT

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

for transfer to the IInd Year Professional Part of Course in the Health Sciences with the copies of the following documents:

i) XIIth Std. Mark sheet & Passing Certificate ( True Copy)

ii) First Professional Examination Mark sheet, Passing & Attempt Certificate, ( True Copy)

iii) No Objection Certificate from Relieving Parent College,

iv) No Objection Certificate from Receiving/ Admitting College,

v) Certificate from the Dean/Principal stating that the present College is recognised by concerned Council.

vi) Medical Certificate ( certifying the illness causing disability )

vii) Admission letter issued by the Competent Authority.

Signature of Receiving Officer

Date :