RAJIV GANDHI UNIVERSITY
OF HEALTH SCIENCES
KARNATAKA, BENGALURU - 560 041.
FOR FOREIGN / SAARC / NRI STUDENTS AND INDIAN
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NATIONALS WITH FOREIGN QUALIFICATIONPlease go though the relevant rules regarding the eligibility for the concerned
course in the university website www.rguhs.ac.in before applying.
1
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Pass postsize Photo
duly signed
by the
Candidate
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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESKARNATAKA, BENGALURU ? 560 041.
APPLICATION FOR ISSUE OF ELIGIBILITY CERTIFICATE
(FILLED IN APPLICATION FORM WITH NECESSARY DOCUMENTS MAY PLEASE BE SUBMITTED TO
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THE REGISTRAR, RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE -560 041.INCOMPLETS APPLICATION NOT BE CONSIDERED)
NAME OF THE COURSE : _______________________
YEAR FOR WHICH ELIGIBILITY IS APPLIED -----------------------------------------.
1. Name of the Candidate
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(in BLOCK letters as in themarks card of the qualifying
Examination)
2. Gender (Sex)
3 Age & Date of Birth
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(in Christian Era)with proof
4 (a) Address for Communication.
(in block LETTERS) with contact
number and email address
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5. Nationality2
6. Passport Details :
a) Passport No.
b) Issuing authority
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c) Date of expiry of Passportd) Nature of Visa held
e) Date of expiry of VISA
7. . QUALIFICATION :
a) Name of the Qualifying
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examination passedb) Register No.
c) Month & Year of examination
held
d) Name of the Board /
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University which conductedthe examination
e) Pattern of Education pursued
for passing the qualifying
examination. i.e. whether it is
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10+2 or any otherpattern. (furnish
supporting / relevant
documents)
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8) Details of Education during the past 6 years before the qualifying examination
Name of the
Address of the
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Month &Sl. Year
Class /
Pattern of
School or College &
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Year ofNo.
Course and
Education
Board / University
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passing theits duration
examination
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2
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34
5
6
9.
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Details of the subjects in qualifyingexamination
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Language
&
Maximum
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MinimumMarks
Percentage
of
Optional subjects
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MarksMarks to pass
Obtained
marks
passed
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Language:1.English
Optionals:
2.Physics (P)
3.Chemistry (C)
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4.Biology (B)5.Mathematics (M)
6.Computer Sciences
(C.Sc)
7. 7.Electronics (Elec)
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6b) Percentage of Marks in Aggregate of:
i) PCB :
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ii) PCM:
iii) PCMB :
iV) PC Com.Sc :
V) PC Elec :
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C)In case of examinations where grades are awarded in the subjects at the qualifying examination, the
equivalent marks for each grade should be furnished.
Language & Optional
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Grade awardedEquivalent
Mean/average
Example :
subjects passed
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marks of themarks of the
grade
grade
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Optional :Grade
Equivalent
Average
1.English
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marksOptionals:
A
91-100
95
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2.Physics(P)B
81-90
85
3.Chemistry(C)
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Note:4.Biology (B)
Candidate should furnish the
5.Mathematics(M)
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table showing the equivalentmarks for each grade issued by
6.Computer Sciences
the examination conducting
(C.Sc)
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authority .7. Electronics(Elec)
d)Percentage of marks in aggregate of
i) PCB
.......................................
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ii) PCB......................................
iii) PCMB
......................................
iv) PC Com.Sc
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.......................................v) PC Elec
........................................
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10. Details of on-line Payment : (to be made in the name of the
applicant only)
Transaction Number
Amount Paid
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Date of PaymentFor Indian Citizens with qualifying examination from aboard, and
Rs. 10,000( for Medical,
For Applicants from SAARC countries and from NRI, OCI, PIO Dental, & AYUSH)
applicants
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Rs. 5000 for other coursesFor applicants from foreign counties
Rs, 40,000 for Medical,
Dental and AYUSH courses
and Rs. 20,000 for other
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courses.11. List of documents required :
(Submit attested photocopies of gazette officer for foreign and NRI applicants. For Indian citizens
with foreign qualification, self attested photocopies is sufficient))
Sl No
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UG DOCUMENTSTick
PG DOCUMENTS
Tick
1.
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SSLC/10th Marks card/TCSSLC/10th Marks card/TC
2.
10+2 /PUC marks card
NEET acceptance result sheet
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3.NEET acceptance result sheet
For PG Candidates All year markscards of UG
(if applicable)
(MBBS/BDS/AYUSH,B.Sc(N), B.Pharm)
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4.*Students Online Payment of Foreign
*Students Online Payment of Foreign
(Rs.40000/- for MBBS/BDS,AYUSH
(Rs.40000/- for MBBS/BDS,AYUSH)
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Students)Rs.20000/- for Other Course Students
(Rs.20000/- for Other course Students)
*Students Online Payment of NRI/SAARC
*Students Online Payment of NRI/SAARC
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Rs.20000/- for MBBS/BDS,AYUSH(Rs.10000/- for MBBS/BDS/BAMS/BNYS)
(5000/- for other Course students
(Rs.5000/- for Other Course Students)
5.
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Equivalence Certificate issued by AIU, NewScreening test pass certificate photo copy/
Delhi
Council Certificate
6..
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Passport Photo copy/NationalityDegree Certificate/ Provisional Degree
Certificate
7.
All document should be self attested by
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Registration Certificate/ PRCStudents
8.
Migrations Certificate
9.
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Two Passport size photoAll document should be self attested by
Students
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Two Passport size photo
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Passport Photo copy12.DECLARATION
I hereby solemnly and sincerely affirm that the statements, information and documents submitted by me
herewith are true to the best of my knowledge belief Should any of it is found to be incorrect, false or fradulant, I
realize that the certificate issued may become null and void. I realize that I am liable for criminal prosecution and I also
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agree to forego my seat. I agree to abide by the rules and regulations of the university.Place :
Date :
SIGNATURE OF THE APPLICANT
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