1

ST SC SCA MBC&DNC BC BC oc (Muslims}

J

................. Years Months (b) Age as on 31.12.2019

7. Community (Put a tick in the appropriate box) (Enclose attested/Xerox~QQY of the _ . permanent community certificate)

6. (a) Date of Birth

5. Sex of the candidate (put a tick .../ correctly)

Male Female I Transgender I D D I

DAY I MONTH I YEAR

·I I I . I

............. ~ • ~ & v ~ 0 •••••••••••••• ~

. .

E-Mail ID

Mobile No.

......................... (PIN CODE) .

• • • • • • • • • • • • • • • • • • • c • • • • • •" • t v t • t • t t t t • • t • "• • • o • • • • • • ~ • • • .. a c

4. Address for communication

•tO+•••••••••••••••••••••••••••••••• .. •••••n•<>OO••v••• .

• • • • • t • • • • • • • • • • • • • • " • • • • • • t " t t • • • • ' • • • •" • n • • • • • • • • "' • • ~ • • "" •

3. Name of Parent I Guardian

• • • • • • • • • "• • • • e <> • .. • o t • • • •" • • • • • e • • • • • • • • • ~ • • • • • t • "' t • 1 4 ~"' o;> •.., n

Space for affixing passport size

photograph duly attested by

Grade A or B Officer of the Central I State -Govt I officer of the

STUs or Head of Institution last studied

NEET Mark 1. Name of Candidate

(IN BLOCK LETIERS)

2. Candidate MOHAR NO

NEET (UG) 2020 Roll No.

NEET (UG) 2020 Application No.

(Through the HEAD of the concerned STU)

THE DIRECTOR, INSTITUTE OF ROAD TRANSPORT,

TARAMANI, CHENNAI '600 113.

Please send the completed application to

IT] 11111111111 l I I I 1 1 I I I l I I I _ I I

THE INSTITUTE OF ROAD TRANSPORT, TARAMANI, CHENNAI 600 113 Application form for admission into First MBBS Degree course (reserved quota)

At Perundurai Medical College, Perundurai for the year 2020-2021

Re No. Rank Communit · Communit Rank For IRT use only MBBS l 2020-21

2

13. Ranking of the candidates will be done based on the Ranking obtained in NEET (UG) 2020 Examination conducted by CBSE,-New Delhi.

THE PERCENTAGES AND THE WEIGHTED TOTAL SHOULD BE ACCURATE TO 2 DECIMALS

• WEIGHTED TOTAL FOR A MAXIMUM OF 200 EITHER (X+Y) OR (Z+Y)

PERCENTAGE INBOTANY & ZOOLOGY TAKEN TOGETHER (Z)

PERCENTAGE INPHYSICS & CHEMISTRY TAKEN TOGETHER (Y) after normalization

(after normalization) PERCENTAGE IN BIOLOGY (X)

12. Weighted Total Marks for a Maximum of 200

•

I MAXIMUM MARKS-1 MARKS OBTAINED ~ SUBJECT

11.a. Marks-Obtained in the fourth optional subject

SUBJECT MAXIMUM MARKS - MARKS OBTAINED i

PHYSICS '

CHEMISTRY BIOLOGY BOTANY I

ZOOLOGY'

11. Marks in. Select Subjects in the First Appearance in Qualifying Examination

Month & Year

PASSING THE QUALIFYING EXAMINATION REG NO

10. Particulars of passing the Qualifying Examination

ENGLISH TAMIL OTHERS

1 2 3

9. Medium of Instruction (Encircle a Code)

HSC SSCE/CBSE l.S.C.E. OTHERS

1 2 3 4

8. QUALIFYING EXAMINATION (EnCircle a code)

3

NOTE: The GUARDIAN can execute the above declaration only if both parents are· not alive.

SIGNATURE OF.THE PARENT I GUARDIAN. DATE:

PLACE:

contained with the above declaration including community. The statements and the information given are true,

correct and complete. If it is found otherwise, the applicant is liable to forfeit the seat and/or be removed from

the institution at whatever may be the stage of study besides making me also liable for criminal prosecution. , '

SIGNATURE OF THE APPLICANT.

- ·DECLARATION B"(_THE PARENT I GUARDIAN

I, (Name iri full and in BLOCK LETTERS) Father I Mother I Guardian of ·······:· hereby solemnly declare that I am fully aware of the

. declaration made by the applicant, my Son I Daughter I Ward and I declare and bind myself on the same terms

- DATE:

PLACE:

I, , , (Name in full and in BLOCK LETTERS) Son /Daughter I Ward of .' ; . . . . . . . . . . . . . . . . .. . .. . . . . . . . . . hereby · solemnly declare that the information furnished

and the statements given in the application, community, coding sheet and the enclosures are true, correct and

complete. I further declare that should it be found otherwise, I would be liable to forfeit my seat and/or be

removed from the rolls of the' institution at whatever stage of study, I may be, besides making me liable for

criminal prosecution.

DECLARATION.BY THE APPLICANT

Name of the Month, Year Name and address Date of discontinuation course From To of college If any

17. If you have been I or presently a student of a Professional College in Tamil Nadu, then furnish particulars (MBBS I BOS I B.PHARMACY I BSc NURSING I BVSc I ENGINEERING / LAW I BSMS I BHMS I BPT I BOT I AGRICULTURE, ETC. If not, write - N A (Not Applicable)

• ••O•o+••••••••••••O••o••••••••••••••••••.•••--•

15. RELIGION

16. MOTHER TONGUE

14. SCHOOL (SJ OF STUDY Month & year of Name and address of school passing

XII Std/equivalent XI Std x Std IX Std VIII Std

·NB: In the case of adopted son/daughter the adoption documents submitted by th~ employee must be verified & signed by DM (legal) for its legal validity and it should be countersigned by the General Manager.

Office Seal:

4

Date: :

Signature of D.M. Personnel I Welfare

Station:

SIGNATURE OF MANAGING DIRECTOR I GENERAL MANAGER I JOINT MANAGING DIRECTOR l DIRECTOR I ADDL DIRECTOR I

SPECIAL OFFICER I DEAN I PRINCIPAL

VERIFIED BY

2. Certified that the parent Thiru I Tmt .. . . .. .. . . . .. .. .. . .. . . .. •.. .. . .. . . .. . .. . .. . . . . . . . .. . . .. .. . . . . .. .. .. is a live

Member of the IRT Medical College Interest Free Loan Scheme.

of Thiru I Tmt .: ; ~ .Is found to be a bonafide Son I Daughter I adopted Son I Daughter of the employee ofthis corporation which has been verified.

' 1. Certified that Selvan I Selvi . Son I Daughter

!

(This certificate is to be issued by the Chief Executive of the Organization to which the applicant's · parent is permanently employed)

FORWARDING NOTE OF THE MANAGING DIRECTOR --------------~---------~--------------.,.--------------~-- .... .,...,..-- ... --...,""'--""'......,_,_

SIGNATURE-OF THE PARENT /-GUARDIAN

Date:

Station:

cJ···~~~=;·······················:~~;· 3. Office/Branch/Workshop/Establishment

in which the parent is working at present

4. Corporation & Region in which employed

5. Relationship to the applicant

2. Designation & Staff Number

1. Name of the Parent

PARENT DETAILS

5

SIGNATURE OF THE APPLICANT.

NEET Mark

I · I I I I I I I I I l . I I I NEET (UG) 2020 Roll No.

l I I I I I l I I I I I I I 12. Details of NEET (UG) 2020

NEET (UG) 2020 Application No.

PHYSICS - CHEMISTRY BIOLOGY

BOTANY

ZOOLOGY FOURTH OPTIONAL SUBJECT

OVERALL TOTAL

MARKS FOR 200 11. Marks Obtained (Highest Marks Obtained In Qualifying Examination):

Register Number · 1 l Year

I I 1 l l l - I _ .______ -"---'-I . ~I ___.______..

o· Y/N

D· 8. Is the parent a member qf the IRTM contribution scheme?

9. Qualifying Examination : (HSC {A}-1; CBSE -2, ISCE -3, Others - 4}

10. + 2 Examlnatlon registe~ number, year & month !

7. Corporation Code{Fill in the appropriate code No)

6. Designation

I ·1 I I 1 I I l J I l I I I I J 1 l i I I ] -1 I I rn rn

5. Parent Name (In BLOCK LETTERS with initials at the end:

4. Community D {ST - 1, SC - 2, SCA - 3, MBC&ONC - 4, BC - 5, BC {Muslims) - 6, OTHERS - 7)

l 1 I l I l 1 ·1 . l. l l ] l I J 1 · I l I I l · 1 I . I J 2. Sex (Male - 1, Female - 2 & Transgender -3} O

DAY MONTH YEAR

3. Date of Birth rn rn rn

1. NAME (IN BLOCK LEITERS with initials at the end:

COMPUTER COOING SHEET NOTE: Read the "Instructions to candidates" before filling up this coding sheet.

6

Note: This penalty Is only for candidates wno discontinue the course and not for realfotment and movement from one to another category. 3.6 (i) The candidate shall, on demand made by the Government within two years from the date on Wtiich he/she registers himself I herself as a Medical Practitioner, serve for a period of not less than five years and in such rural areas as the Government may by General or Special orders specify. (ii) Those candidates wno fall to comply with above shall have lo pay a sum of Rs.5,00,000/- (Rupees five Lakhs only) or as the Government may direct as penalty for having breached the contract bond. 4. METHOD OF SELECTION AND ADMISSION:

4.1 Selection for admission to MBBS COurse at Perundural Medical COiiege under MANAGEMENT QUOTA seals for wards of employees of STUs/lRT/PTCS/TDFC and who are member of the scheme will be as detailed in section 4.1 to 4.3. 4.2 Ranking will be made on merit on the basis of Ranking in 2020 NEET(UG) Examination conducted by CBSE, New Delhi. 4.3 The list of candidates eligible will be sent to Government of Tamil Nadu for approval. On approval of the list, counselling will · be conducted on the basis of merit list and seats will be allotted In the order of merit. 5. COUNSELLING: 5.1 Admission shall be made by counseling according to merit and availability of seats by following the rule of reservation as under:

1.GENERAL:

1.1 The Children of employees STUs, PTCS, TDFC, IRT, Wtio . are applying for admission to the PERUNDURAI MEDICAL COLLEGE of Institute of Road Transport under MANAGEMENT QUOTA, may apply for admission to the Medical.COiiege under the control of Director of Medical Education. 1.2 The legally adopted son I daughter of the employee will also be considered for admission. 1.3 The children of the deceased I retired employee will not be considered for admission unless the deceased I retired employee's name is on the live roll of the scheme. 1.4 There is no quota for B.Sc. Graduates. 1.5 The employees wnose ward Is applying under this management quota must be a live member of the IFL Scheme forPMCH. 1.6 Based on the directions given by the Government of Tamil Nadu at time to time, the selection is based on the rank obtained In the NEET (UG) 2020 Examination conducted by CBSE, New Delhi and as per the Guidelines of DME Tamil Nadu -Government. 2. AGE LIMIT:

2.1 The candidate should have completed the age of 17 years on or before 31.12.2019. No request for relaxation of the age limit will be entertained. 2.2 The date of birth and age as entered in the Transfer Certificate Issued after completion of HSC (ACADEMIC), CBSE, ISC or any other equivalent course shall alone be accepted. 3. ELIGIBILITY: Open COmpetition 31%

Backward Classes 30 % 3.1 ·The Candidate should have appeared NEET (UG) 2020 · Most Backward Classes 20 %

.Examination conducted for admission \to MBBS (UG) Course by Scheduled Castes 18 % CBSE, New Delhi. Scheduled Tribes 1 % . 3.2 Minimum qualification for MBBS: Candidates should have Within the 30% reservation for Backward Classes, 3.5% will be passed in · the subjects of, Physics, Chemistry, provided for Muslims and 16% ·of seats out of the 18% quota Biology/Biotechnology and English individually and must have earmarked to Scheduled Caste shall be allocated to the obtained a minlmu.m t>f 50% marks taken together in Physics, Arunthathiyar community. Chemistry and Biology/ Bio-techn,ology at the qualifying BC, BCM, MBC I DNC, SC, SCA, ST candidates are eliglble for Examination. In respect of candidates belonging to Scheduled Selection under open competition as per merit in addition to the Castes, Scheduled Caste Arunthathiyar, Schedul~ Tribes, reservation made for those categories. counselling Schedule Backward Class, Backward Class (Muslim) and Most Backward will be available on the official websites only. . Class I Denotified community, the minimum marks obtained in · 5.2 In order to be eligible for admission to MBBS course for a Physics, Chemistry and Biology/ Bio-technology taken together. particular academic year, It shall be necessary for a candidate to In qualifying examination shall be 40% instead of 50%. In respect obtain minimum of marks at 50111 ·percentile in "National Eligibillty of candidates with locomotory disability of lower limbs, the cum-Entrance Test of MBBS courses" held for the year

-minimum marks In q1,1alifylng examination in Physics, Chemistry· 2020 - 21. However, In respect of candidates ·belonging to and Biology I Bio-technology taken together In qualifying scheduled castes, Scheduled Tribes, Backward Classes, examination shall be 45% instead of 50%. Backward Classes (Muslim) and Most backward Class I de- 3.3 Candidates who have passed any other equlvrJ.ent Notified community the minimum marks shall be at 40111 examination with the same group of subjects as mentioned percentile, on "National Eligibility cum-Entrance Test to MBBS above shalf alscbe eligible for consideration for admission to the course" held for the said academic year; . In respect of FIRST YEAR MBBS course. It shall be the responsibility of the . candidates with locomotory disability of lower limbs terms of candidate concerned to obtain the necessary eligibility certilieate clause 4(a) Iv (of regulations), the minimum mark shall .be at 45u. from Tamil Nadu Dr. M.G.R. Medical University and submit percentile In National Eligibility cum-Entrance Test to MBBS before admission to the course. • course" held for the said academic year. 3.4 Private candidates, wno have passed Higher Secondary 5.3 Candidates will be called for counselljng as per their rank Certificate (HSC) or In the equivalent Board examination in the and individual call letters will be sent by post IRT is not Vocational Stream as their elective or specialization are NOT responsible for delay or non-receipt of call letters. ELIGIBLE for admission to MBBS course. . ' 5.4 An intimation or call letter calling for counselling does not 3.5 (i) Candidates selected for admission and his I her parent I guarantee for admission since more number of candidates are Guardian will have to execute an Agreement Bond during • called than the actual number of vacancy seats.

• admission to the College as prescribed In Annexure. Failure to 5.5 If the ranking of candidate get altered due to re totaling / execute the Agreement Bond will lead to cancellation of revaluation of marks, the candidate cen attend the counselling as selection. · per the new marks and rank, though the call letter specifies

(Ii) Candidates who discontinue the course between 301h different date, wnich Is as per original mark, Jurie and 7th July of the year of admission are bound by the bond and thereby they shall have to pay a sum of Rs.1,00,000/- 5.6 Due to unavoldable circumstances, If the candidate Is unable (Rupees One Lakh only) as a penalty for having breached the to attend the counselling on the specified date their parent can contract In the bond and the candidates wno discontinue the attend the counselling on behalf of the candidates and the course after completion of admission process and In any date of parents' decision will be binding on the candidate

_ JIJ.!'l. ~ubs~y_~nt ye<lr sh£!1J _~\le to P<lY the totalf~~~fQr !_fl_e entire __ 5. 7 Due to unforeseen reasons, If a candidate could not attend remaining period as a penalty. The candidates are instructed to --- the counselling on the speCflfod-date and time, ihe candidatecan- . submit the bond during· admission in the college In the fonnat attend on a subsequent date I time, during the eounselling. But described. the candidate can only opt for the seats available at that time

and cannot claim any seat as per original rank

THE INSTITUTE OF ROAD TRANSPORT. TARAMANI. CHENNAI 600 113 MBBS ADMISSION 2019-2020

Instructions to Candidates (Should not be attached with the filled In application fonn)

-Please Refer Directorate of Medical Education Website and Press Release for latest updates

7

< •

THE DIRECTOR INSTITUTE OF ROAD TRANSPORT

CHENNAI 600113

10.The tuition fee is Rs.3,85,000/~ (Subject to revision)

9.1 Submission of an application does not give any right for clafmlng a seat later. 9.2 The application fonn must be routed trough the Managing Director of the parent corporation of the employee and the forwarding note of the Managing Director is to be signed only by the Managing Director of parent Organisation.

9.3 The forwarding note is to be signed only by the Managing Director and not by any other officer.

9.4 The admission done by !RT is strictly provisional and will be confinned only after getting the approval of Director of Medical EducaUon. The selectlon and admission is liable to be cancelled any time as and when the eliglbllity conditions are round to be defective in addition to revelaUon of suppressed and overlooked facts.

9.5. Any further guidelines I instructions issued by the secretary, Selection Committee, Medical Admissions will be followed.

9. OTHER IMPORTANT POINTS;

I) Transfer ce~fioate obtained after the completion of HSC (Academic) or equivalent courses.

ii) Pennanenl Community Certificate Card.

iii) Legally valid documents if the candidate Is an adopted son I daughter.

No doc.ument enclosed with the application will be returned. The candidates are required to enclose only the attested Xerox copies or attested true copies of the following certificates along

· with the application. Attestation should have been made by Grade - A or Grade - B Officer of the State Government or -Central Government or· by Head of the Institution where the candidate studied, or by an officer of State Transport Undertaking. Mark-sheet(s) of HSC (Academic) examinations in an appearance or equivalent examination of the first appearance (both the sides of mark-sheets should be xeroxed) (or) Mark Sheet downloaded from the Internet. Note: The Admission will be made as per the Guide line given by the Director of Medical Education, Chermai.

i

All the candidates selected for I Year MBBS at Perundurai Medical College should take the Hepatitis-B-Anti-lnfection Injection before admission to the course and that only on producing proof for such dose, the Dean, Perundural Medical College will admit these candidates. The students'shoutd take further doses atthe prescribed intervals as required.

8. ENCLOSURES:

7. ANTI HEPATITIS INFECTION INJECTION:

5.8 candidates who do not attend the counselling may have to forgo the clalm,of admission. 5.9 candidate, who selected a seat during counselling, but not joining the college will forfeit the counselling fees 5.10 The Guidelines issued by DME for admission for MBBS Course In 2020-21 will be followed,

6. NUMBER OF SEATS:

Out of the total 100 seats 15 seats are filled by All India Government Quota. For the remaining {35 seats 30 seats are reserved for the wards of the employees of the STUs.

12. Tl)~ Candidate ~-llQIJlc:f_h.i_:iy~ app~a_red.~l;T (~_G_l_?.()70 . Examination conducted for admission to MBBS (UG) Course by CBSE, New Delhi

8. If the parent is a live member of the IRTM Contribution Scheme? D Write 'Y' and if not write 'N' In the box ·

9. Qualifying Examination: Enter the code number given against your qualifying examination and year of pas~!ng

HSC (Academic 1 ISCE 3 HSC (CBSE) 2 Others 4 Year of passing I 2 I 0 "TrJJ[]

10. HSC Register Number, Year of Passing and Month 11. Total Marks Obtained: Enter your marks in the given box

Example: Mari<s obtained 95 TOBEENTEREOAS I 0 I 0 I 9 L( I

the Corooratlon where your parent is employed. Name of STU Code

MTC, Chennai 01 SETC, Chennai 02 TSTC, Coimbatore 03 TSTC,Erode 04 TSTC,Salem 05 TSTC, Dharmaourt 06 TSTC, Villuouram 07 TSTC, Vellore 08 TSTC, Kancheeouram 09 TSTC, Tiruvannamalai 10 TSTC, Tlruvallur 11

. TSTC, Cuddalore 12 TSTC, Kumbakonam 13

' TSTC, Trichy 14 TSTC, Karaikudi 15 TSTC, Pudukottai 16 TSTC, Madurai 17 TSTC. T!runelveli 18 TSTC, Nagercoil 19 TSTC, Dlndigul 20 . TSTC, Virudhunaciar 21 PTCS, Chennai 22 TDFC, Chennai 23 . IRTChennai 24 IRT,GPD 25 IRTT,Erode 26 IRTPMCH 27 IRTPC Chromepet 28 IRTPC Tirunelveli 29 IRTPC Barciur 30

7 Corporation Name: Wnte the corresponding Code Number of

E FILLED IN APPLICATION FORM) . _,.__ GD Steno Typist GE Senior Steno Tvoist HA Staff Nurse HB Senior Staff Nurse HC Selection Grade Staff Nurse IA Security Guard IB Senior Grade Security Guard IC Selection Grade Securitv Guard ID Mazdoor I Sweeper JA Tradesman JB Junior Tradesman JC Asst. Tradesman JD Senior Tradesman JE Selection Grade Tradesman JF Foreman JG General Foreman JH Workshoo Superintendent JI Wireman JJ Mechanic JK ' Electrician - JL Blacksmith JM Tinker JN Fitter zz All others

oaren s es1anat1on om t e 1st. Code . Designation AA. Senior Manaaer --- AB Manaaer -- AC Senior Oeoutv Manager AO · Deoutv Manaaer/Senior Asst. Manaoer · AE Asst. Manager/Branch Manager of A.M. Cadre ·- BA Asst. Enoineer/ABM or BM of AE Gadre BB Junior Engineer/BM OF JE Cadre CA Conductor i

CB Senior Grade Conductor cc Selection Grade Conductor 1 CD Asst. Branch Manaoer ITrafficl CE Checking lrisoector CF Senior Grade Cl CG Selection Grade Cl CH Traffic lnsoector Cl Traffic Manager I Senior Traffic Manager, CJ Time Keeoer

.. _DA Driver DB Senior Grade Driver DC Selection Grade Driver .. OE Drivino Instructor EA Junior Assistant I Office Assistant EB Assistant EC Senior Assistant ED Selection Grade Assistant EE Junior Clerk I Tel. Ooerator I Store Keeoer EF Clerk EG Senior Clerk EH Selection Grade Clerk El Works Clerk EJ Cashier EL Senior Cashier EK Selection Grade Cashier ' EM Attender I Peon I Heloer FA Office Suoerintendent FB Junior Superintendent FC Senior Suoerintendent FD Selection Grade Superintendent FE Office Manaoer FF Section Officer FG Welfare Inspector FH -Piib1TCRe1auons·omeer· .. - .... - ...

GA Typist GB Senior Tvoist GC Selection Grade Typist

!s·IAINlrJHJAJNjAJMl.jKJ] J )j 6. DESIGNATION: Write the corresponding code of your

t'dl lonfr hr

5. PARENTS NAME: (In Block Letters with Initials at the end) Enter your parent's name as given in the example below:. EXAMPLE: Name: K. SANTHANAM TO BE ENTERED AS .

Backward Class 5 Backward 6 Class(Muslim) Others 7

..

to vou eong Scheduled Tribe 1 Scheduled Caste 2

SCA 3 MBC&DC 4

TI H jAJNJDJAjPjA]Nj1J.)sl I I 2. 'Sex:

If male, Enter GJ If female, Enter G In the box

3. Date of Birth: Enter your date of birth as given in the example - Date of Blrth.--o9....,.,,...o8,..,..-=-19_8 ... 7~-::-:-:=-:-.--:-=--=--.

TO BE ENTERED AS 1 ~AY ] MONTH J YEAR _ o )9)ol8J8l7 4. Community: Enter the code number given against the caste

which b I

INSTRUCTIONS TO CANDIDATES TO FILL UP THE COMPUTER CODING SHEET (SHOUtO NOT BE ATTACHE;D WITH TH

1. Name: (In BLOCK LETTERS with initial(s) at the end) Enter your name as given in the example below. EXAMPLE: Name: THANDAPANI. S

TO BE ENTERED AS

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