Shimoga Institute of Medical Sciences, Shimoga

DECLARATION (NOTARISEDBONDTOBEEXECUTEDONE-STAMPPAPEROF RS.100/-) To TheDirector, ShimogaInstituteofMedicalSeiences, Shivamogga. Sir/Madam, MBBS2025-26 NAMEOFTHECANDIDATE FATHER’SNAME UGNEETROLLNO. UGNEETRank TYPEOFALLOTMENT AIQ/SQ IRound IIRound MOPUPRound StrayVacancyRound CATEGORYCLAIMED GM / CatI / CatIIA / CatIIB / CatIIB / CatIIIA / CatIIIB / OBC / SC / ST CATEGORYALLOTTED GM / CatI / CatIIA / CatIIB / CatIIB / CatIIIA / CatIIIB / OBC / SC / ST eMail MobileNo I S/o,D/o residing at have joined the allotted MBBS seat at Shimoga Institute of Medical Sciences during the Academic year 2025-26on (date)do herebyundertake as follows. I have submitted all the required Original Certificate at time of admission for the approval of MBBS admission seat. If found fake or colour Xerox I will be held responsible for the same and I am liable for criminal proceedings if any one of the above information/documents produced by me is found tobefalse/incorrect. Place:Shivamogga Date: SignatureofParent/Guardian SignatureofCandidate 1st Party : The Candidate 2nd Party : The Director, SIMS, Shivamogga NOTARISEDINDEMNITY BONDTOBEEXECUTED ON AE-STAMP PAPER OFRS.100/- FORCANDIDATESWHOSELECTMBBSSEATSINGOVERNMENTMEDICALCOLLEGEORGOVERNMENTSEATS INPRIVATEMEDICALCOLLEGES MBBS2025-26 NAMEOFTHECANDIDATE FATHER’SNAME UGNEETROLLNO. UGNEETRank TYPEOFALLOTMENT AIQ/SQ IRound IIRound MOPUPRound StrayVacancyRound CATEGORYCLAIMED GM / CatI / CatIIA / CatIIB / CatIIB / CatIIIA / CatIIIB / OBC / SC / ST CATEGORYALLOTTED GM / CatI / CatIIA / CatIIB / CatIIB / CatIIIA / CatIIIB / OBC / SC / ST eMail MobileNo ForalleStamppapers  1stpartyis thecandidate&  2ndpartyistheDirector,DirectorateofMedicalEducation,Karnataka MBBS2025-26 NAMEOFTHECANDIDATE FATHER’SNAME UGNEETROLLNO. UGNEETRank TYPEOFALLOTMENT AIQ/SQ IRound IIRound MOPUPRound StrayVacancyRound CATEGORYCLAIMED GM / CatI / CatIIA / CatIIB / CatIIB / CatIIIA / CatIIIB / OBC / SC / ST CATEGORYALLOTTED GM / CatI / CatIIA / CatIIB / CatIIB / CatIIIA / CatIII