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Masters in Hospital Administration (MHA) HIHT University

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<strong>Masters</strong> <strong>in</strong> <strong>Hospital</strong> Adm<strong>in</strong>istration (<strong>MHA</strong>)<br />

INFORMATION BROUCHRE & APPLICATION FORM<br />

<strong>HIHT</strong> <strong>University</strong><br />

Swami Ram Nagar<br />

P.O. Doiwala, Dehradun-248140<br />

Uttarakhand (INDIA)<br />

Phone: 0135-2471155, 150, 156<br />

1


<strong>HIHT</strong> UNIVERSITY<br />

(Deemed <strong>University</strong>)<br />

(Under Section 3 of UGC Act 1956)<br />

(Notification No. 9-43/2006-U.3 (A) dated 6 th June 2007)<br />

Swami Ram Nagar, Doiwala, Dehradun 248140<br />

ANNOUNCEMENT FOR<br />

MASTER IN HOSPITAL ADMINISTRATION (<strong>MHA</strong>) COURSE<br />

1. GENERAL<br />

<strong>HIHT</strong> <strong>University</strong> has been granted deemed to be <strong>University</strong> status vide notification no.<br />

F.9-43/2006-U.3(A) dated 6th June, 2007 by the Govt. of India, M<strong>in</strong>istry of Human Resource<br />

Development.<br />

About <strong>HIHT</strong> <strong>University</strong><br />

The <strong>HIHT</strong> <strong>University</strong> established under the aegis of the Himalayan Institute <strong>Hospital</strong> Trust, is<br />

founded by H.H. Dr. Swami Rama, who was a great yogi, scientist, philosopher, philanthropist,<br />

researcher and writer. Spread over 200 acres of land, the campus is situated <strong>in</strong> the<br />

picturesque surround<strong>in</strong>gs of foothills of Himalayas <strong>in</strong> Garhwal region. It offers graduate and<br />

post graduate courses <strong>in</strong> medical and paramedical fields under the guidance of a proficient<br />

faculty committed to academic and professional excellence.<br />

It is a unique model of education <strong>in</strong> the country. Emphasis is on community oriented medical<br />

education focus<strong>in</strong>g on preventive, promotive, curative health care, evolv<strong>in</strong>g a new pattern of<br />

medical education and health and modern technology and tra<strong>in</strong><strong>in</strong>g students <strong>in</strong> the science and<br />

art of medic<strong>in</strong>e, match<strong>in</strong>g with <strong>in</strong>ternational standards.<br />

The <strong>University</strong> is situated <strong>in</strong> the foothills of the Himalayas on the Dehradun - Rishikesh<br />

Highway, 25 kms from Dehradun and 18 kms from Rishikesh. The Institute presently has a<br />

multi-specialty <strong>Hospital</strong> along with residences for Doctors and Staff.<br />

Himalayan Institute <strong>Hospital</strong><br />

The Himalayan Institute <strong>Hospital</strong> is a 750 bed multi-specialty world class teach<strong>in</strong>g hospital.<br />

The hospital has of almost 80% bed occupancy throughout the year. The judicious blend of<br />

cl<strong>in</strong>ical expertise aided with latest medical facilities and personalized care at <strong>Hospital</strong> puts us<br />

at a higher pedestal than others <strong>in</strong> the area. Each specialty has lead<strong>in</strong>g full-time consultants,<br />

backed by skilled and highly qualified nurs<strong>in</strong>g and para-medical staff to provide world class<br />

services <strong>in</strong>clud<strong>in</strong>g 24/7 emergency services. The ultra-modern Intensive Care Unit, Cardiac<br />

Care Unit (CCU), Neonatal ICU, Peadiatric ICU and an Operation Theatre complex with 10<br />

operat<strong>in</strong>g rooms are the pride of this region.<br />

Apart from provid<strong>in</strong>g comprehensive health services the hospital focuses on super specialty<br />

services like cardiology/cardiac surgery, urology/nephrology, neuroscience, plastic surgery,<br />

orthopaedics, Sleep Cl<strong>in</strong>ic, epilepsy cl<strong>in</strong>ic, diabetic foot care cl<strong>in</strong>ic, glaucoma cl<strong>in</strong>ic,<br />

2


Vitreoret<strong>in</strong>al Services. <strong>Hospital</strong> has a dedicated cancer care centre, kidney transplant unit,<br />

blood bank, eye bank, artificial limb centre, and Integrated Counsel<strong>in</strong>g and Test<strong>in</strong>g Center<br />

(ICTC).<br />

The hospital pharmacy provides an easy access of drugs to the OPD and IPD patients at a<br />

price lower than the market price.<br />

Master <strong>in</strong> <strong>Hospital</strong> Adm<strong>in</strong>istration (<strong>MHA</strong>) Course<br />

The rapid and cont<strong>in</strong>uous growth <strong>in</strong> healthcare technology, <strong>in</strong> recently years, has made it<br />

crucial to have both knowledge of overall function<strong>in</strong>g of hospitals as well as effective quality<br />

healthcare delivery system for patients.<br />

The hospitals are attract<strong>in</strong>g <strong>in</strong>ternational patients through medical tourism. India has become<br />

one of the lead<strong>in</strong>g dest<strong>in</strong>ation for such <strong>in</strong>ternational patients with its highly skilled medical<br />

professionals and very cheap treatment cost.<br />

An important role of a hospital adm<strong>in</strong>istrator is to be able to act as a successful <strong>in</strong>termediary<br />

between govern<strong>in</strong>g boards, medical staff, and department heads and <strong>in</strong>tegrate the activities of<br />

all departments so they function smoothly as a whole.<br />

Today the healthcare <strong>in</strong>dustry is look<strong>in</strong>g for bright and highly professional hospital<br />

adm<strong>in</strong>istrators who can play a major part <strong>in</strong> improv<strong>in</strong>g health care delivery systems <strong>in</strong><br />

corporate hospitals, government hospitals, diagnostic centre, pharmaceutical <strong>in</strong>dustries, health<br />

care market<strong>in</strong>g, health care <strong>in</strong>frastructural plann<strong>in</strong>g and development sector etc. A person with<br />

<strong>MHA</strong> degree can also opt to open their own hospital and <strong>in</strong> turn generate employment<br />

opportunity for others apart from academic enhancement to the extent of acquir<strong>in</strong>g doctorate<br />

degree.<br />

Tak<strong>in</strong>g note of this ris<strong>in</strong>g requirement of healthcare adm<strong>in</strong>istrators, the <strong>University</strong> has started a<br />

post graduate programme <strong>in</strong> <strong>Hospital</strong> adm<strong>in</strong>istration with the follow<strong>in</strong>g objectives:<br />

Objectives of the Programme:<br />

• To provide knowledge about healthcare and hospital adm<strong>in</strong>istration to medical & nonmedical<br />

persons who aspire to make a career <strong>in</strong> hospital/healthcare <strong>in</strong>dustry.<br />

• To equip students with the necessary, management <strong>in</strong>puts for efficient & effective<br />

management of hospitals.<br />

• To provide knowledge relat<strong>in</strong>g to complex technical health adm<strong>in</strong>istrative problems.<br />

• To expose students to the vibrant areas of the hospitals/healthcare organizations so as<br />

to provide hands on teach<strong>in</strong>g/tra<strong>in</strong><strong>in</strong>g.<br />

• To provide <strong>in</strong>sights <strong>in</strong>to every aspect of various <strong>in</strong>ter-related functions <strong>in</strong>clud<strong>in</strong>g cl<strong>in</strong>ical<br />

care requirement, f<strong>in</strong>ancial & legal matters, personnel management, logistic<br />

management, eng<strong>in</strong>eer<strong>in</strong>g applications as well as market<strong>in</strong>g & public relations.<br />

• To identify <strong>in</strong>formation needs and develop skills for the efficient use of <strong>in</strong>formation<br />

towards f<strong>in</strong>ancial & operational success of the hospitals.<br />

• Capacity Build<strong>in</strong>g – State/District Health Officers, <strong>Hospital</strong> Managers & Adm<strong>in</strong>istration,<br />

pass<strong>in</strong>g Managers & Adm<strong>in</strong>istration & NGOs.<br />

• Dissem<strong>in</strong>ation - Organiz<strong>in</strong>g sem<strong>in</strong>ars, workshops & conferences.<br />

3


• Institution build<strong>in</strong>g – Synergy with other <strong>in</strong>stitutions.<br />

• Research Projects – Policy, plann<strong>in</strong>g & evaluation, build<strong>in</strong>g Health Systems.<br />

The <strong>University</strong> <strong>in</strong>vites application from the eligible candidates for admission <strong>in</strong>to Master<br />

<strong>in</strong> <strong>Hospital</strong> Adm<strong>in</strong>istration (<strong>MHA</strong>) – Non Medical Course. The details of the course are as<br />

follows:-<br />

2. DURATION OF COURSE AND SEATS AVAILABLE<br />

The Master <strong>in</strong> <strong>Hospital</strong> Adm<strong>in</strong>istration (<strong>MHA</strong>) course is a full time two year course which<br />

comprise of 4 (four) semesters (six months each). The fourth semester will consist of<br />

<strong>in</strong>ternship dur<strong>in</strong>g which student will be deployed at <strong>HIHT</strong> <strong>Hospital</strong> on full-time basis for ga<strong>in</strong><strong>in</strong>g<br />

practical knowledge. The annual <strong>in</strong>take is 20 students each academic year.<br />

3. Eligibility<br />

(i) Graduate with Diploma <strong>in</strong> <strong>Hospital</strong> Adm<strong>in</strong>istration (Non-Medical Graduate) OR<br />

(ii) MBBS/BDS/BAMS/BHMS/BUMS/Any Medical Graduate degree/B.Sc Nurs<strong>in</strong>g/ BPT/<br />

BMLT/ B.Pharma recognized by Govt of India OR<br />

(iii)<strong>Masters</strong> Degree <strong>in</strong> any discipl<strong>in</strong>e recognized by UGC with a m<strong>in</strong>imum of at least three<br />

years adm<strong>in</strong>istrative/allied experience <strong>in</strong> a healthcare organization.<br />

The upper age limit shall be 35 years as on 31.12.2011. However, relaxation <strong>in</strong> age shall be<br />

applicable to the sponsored candidates. The sponsored candidates shall be required to submit<br />

‘No Objection Certificate’ from the employer along with the application form.<br />

4. METHOD FOR SUBMISSION OF APPLICATION FORM<br />

(i)<br />

(ii)<br />

(iii)<br />

(iv)<br />

(v)<br />

A candidate seek<strong>in</strong>g admission to the Entrance Exam<strong>in</strong>ation is required to send<br />

his/her application <strong>in</strong> the prescribed format.<br />

The candidate should fill <strong>in</strong> the application form <strong>in</strong> his/her own handwrit<strong>in</strong>g (<strong>in</strong> capital<br />

letters) clearly and legibly.<br />

Furnish<strong>in</strong>g of false <strong>in</strong>formation or suppression of material <strong>in</strong>formation <strong>in</strong> the<br />

application form will entail disqualification and shall render the candidate unfit for<br />

admission. If <strong>in</strong>eligibility is detected at any stage, the candidature/admission will be<br />

treated as cancelled and no further correspondence <strong>in</strong> this regard will be<br />

enterta<strong>in</strong>ed.<br />

Incomplete application form will be rejected and no correspondence will be<br />

enterta<strong>in</strong>ed by the <strong>University</strong> <strong>in</strong> this regard.<br />

It will be the responsibility of the candidate to ensure that the correct address is filled<br />

<strong>in</strong> the Application Forms. The <strong>University</strong> shall not be responsible for any loss <strong>in</strong><br />

transit or for <strong>in</strong>correct address given by the applicant <strong>in</strong> the Application Form.<br />

4


(vi)<br />

(vii)<br />

No candidate should submit more than one application. However, if submission of<br />

another application becomes necessary for any reason, the word “Duplicate” be<br />

clearly mentioned <strong>in</strong> red <strong>in</strong>k on top of the second application. Failure to do so may<br />

entail rejection of both applications.<br />

Candidate is required to go through the check list before send<strong>in</strong>g his/her application<br />

form.<br />

(viii) Application form complete <strong>in</strong> all respect along with a Demand draft for Rs. 2000/-<br />

(Rupees two thousand only) should be sent to the Controller of Exam<strong>in</strong>ations,<br />

<strong>HIHT</strong> <strong>University</strong>, Swami Ram Nagar, Doiwala, Dehradun 248140 (Uttarakhand)<br />

by speed post/registered post or deposited by hand <strong>in</strong> the office of the Registrar.<br />

(ix)<br />

Demand Draft shall be <strong>in</strong> favour of <strong>HIHT</strong> <strong>University</strong> payable at State Bank of<br />

India, Jolly Grant (Branch code No- 10580), Dehradun.<br />

NOTE: Candidates are strongly advised not to approach any <strong>in</strong>dividual or agency for<br />

admission. This <strong>University</strong> has no branches and no <strong>in</strong>dividual/agency is authorized to<br />

act on its behalf. Admission to Master <strong>in</strong> <strong>Hospital</strong> Adm<strong>in</strong>istration (<strong>MHA</strong>) Course is solely<br />

based on the merit.<br />

5. CHECK LIST<br />

Before send<strong>in</strong>g the Application form, candidate must ensure that self attested<br />

photocopies of the follow<strong>in</strong>g documents are sent along with duly filled Application Form.<br />

(i)<br />

(ii)<br />

(iii)<br />

(iv)<br />

(v)<br />

Date of birth certificate or High School certificate conta<strong>in</strong><strong>in</strong>g date of birth.<br />

Mark sheets of exam<strong>in</strong>ations (all professional exam<strong>in</strong>ations) of Graduate and / or<br />

Diploma <strong>in</strong> <strong>Hospital</strong> Adm<strong>in</strong>istration/MBBS/BDS/BAMS/BHMS/BUMS/Any Medical<br />

Graduate Degree/B.Sc Nurs<strong>in</strong>g/BPT/BMLT/B.Pharma recognized by Govt of<br />

India.<br />

Qualify<strong>in</strong>g degree or Provisional pass<strong>in</strong>g certificate.<br />

Four recent passport size coloured photographs<br />

‘No Objection Certificate’ <strong>in</strong> case of sponsored candidates.<br />

Note; It is the candidate’s responsibility to ensure that the required qualifications for<br />

admission to the chosen program are submitted. In case any lacuna is found after<br />

admission and enrollment is denied by the affiliated <strong>University</strong>, the Institute shall not be<br />

responsible for any f<strong>in</strong>ancial loss, direct or <strong>in</strong>direct on this account.<br />

5


6. COURSE FEE<br />

Fee Structure for <strong>Masters</strong> <strong>in</strong> <strong>Hospital</strong> Adm<strong>in</strong>istration course will be as follows:<br />

S No Particulars Ist Semester IInd Semester IIIrd Semester IVth Semester<br />

1 Admission Fee 20,000 - - -<br />

2 Tuition Fee 35,000 35,000 35,000 35,000<br />

3 Univ. Enrolment Fee 2,000 - - -<br />

4 Security (Refundable) 15,000 - - -<br />

5 Vacc<strong>in</strong>ation* 1,000 - - -<br />

6 Uniform Charges 5,000 - - -<br />

TOTAL 78,000 35,000 35,000 35,000<br />

7 Univ. Exam<strong>in</strong>ation Fee As per the <strong>HIHT</strong> <strong>University</strong> Guidel<strong>in</strong>es<br />

* If previously vacc<strong>in</strong>ated deposit the certificate of vacc<strong>in</strong>ation.<br />

In case a candidate is not able to complete the course <strong>in</strong> stipulated period of time, extra fees<br />

shall be charged.<br />

6


Def<strong>in</strong>ition<br />

BAN ON RAGGING<br />

Ragg<strong>in</strong>g means caus<strong>in</strong>g <strong>in</strong>duc<strong>in</strong>g compell<strong>in</strong>g or forc<strong>in</strong>g a student whether by way of a practical<br />

joke or otherwise to do any act which detracts from human dignity or violates his person or<br />

exposes him to ridicule or to forbear from do<strong>in</strong>g any lawful act by <strong>in</strong>timidat<strong>in</strong>g, wrongfully<br />

restra<strong>in</strong><strong>in</strong>g, wrongfully conta<strong>in</strong><strong>in</strong>g or <strong>in</strong>jur<strong>in</strong>g him or by us<strong>in</strong>g crim<strong>in</strong>al force to him or by hold<strong>in</strong>g<br />

out to him any threat of such <strong>in</strong>timidation, wrongful restra<strong>in</strong>t, wrongful conf<strong>in</strong>ement, <strong>in</strong>jury or<br />

the use of crim<strong>in</strong>al force. Supreme Court of India has def<strong>in</strong>ed ragg<strong>in</strong>g as a crim<strong>in</strong>al offence. -<br />

Penalty for ragg<strong>in</strong>g (Section, 116 of the Act)<br />

1. No person who is a student <strong>in</strong> an educational <strong>in</strong>stitution, <strong>in</strong>clud<strong>in</strong>g an <strong>in</strong>stitution<br />

under the management of the university or of the central government shall<br />

commit or abet ragg<strong>in</strong>g.<br />

2. Any person who <strong>in</strong>dulges <strong>in</strong> or abets ragg<strong>in</strong>g shall on conviction be punished with<br />

imprisonment for a term which may extend to one year. Ragg<strong>in</strong>g is a crim<strong>in</strong>al and<br />

non-bailable offence.<br />

Warn<strong>in</strong>g<br />

No leniency will be shown to the offenders <strong>in</strong>volved <strong>in</strong> ragg<strong>in</strong>g. All students are requested to<br />

note and co-operate <strong>in</strong> keep<strong>in</strong>g our <strong>University</strong> and its constituent colleges free from ragg<strong>in</strong>g.<br />

Note: The above undertak<strong>in</strong>g to be given on a stamp paper of Rs 10/-<br />

7


<strong>HIHT</strong> UNIVERSITY<br />

MASTERS IN HOSPITAL ADMINISTRATION COURSE-2011<br />

APPLICATION FORM<br />

1. Name of the Candidate : ---------------------------------------------------------<br />

2. Father’s Name : ----------------------------------------------------------<br />

3. Date of Birth : ----------------------------------------------------------<br />

4. Permanent Address : ----------------------------------------------------------<br />

& Phone No.<br />

----------------------------------------------------------<br />

Attested<br />

photograph<br />

5. Present Address : ----------------------------------------------------------<br />

& Phone No.<br />

----------------------------------------------------------<br />

6. Category<br />

(General/OBC/SC/ST) : ----------------------------------------------------------<br />

7. Education Qualification : (Self attested photocopy of the documents to be submitted<br />

with the application - High School onwards)<br />

Name of Exam. <strong>University</strong> /<br />

Board<br />

Subjects Marks obta<strong>in</strong>ed % age of Marks<br />

8. Internship (if any) : Completed / Likely to be completed on -----------------------------<br />

(Documentary proof required)<br />

9. Work Experience (if any): ---------------------------------------------------------------------------------<br />

Declaration :-<br />

I affirm that the statements made and <strong>in</strong>formation furnished by me <strong>in</strong> the application<br />

form is true and correct. If, however, it is found that any <strong>in</strong>formation furnished here is<br />

fraudulent, <strong>in</strong>correct or untrue, immaterial particulars, I realize that I am liable to crim<strong>in</strong>al<br />

prosecution and my selection and admission to the programme is liable to be cancelled.<br />

Date:<br />

Place :<br />

Candidate’s Signature & Name<br />

8


Appendix – I A<br />

AFFIDAVIT BY THE STUDENT<br />

Before the Dean, Himalayan Institute of Medical Sciences, <strong>HIHT</strong> <strong>University</strong>,<br />

Swami Ram Nagar, Doiwala, Dehradun.<br />

1. I, Mr./ Mrs./ Ms./ Dr.______________________________________________ ______(full<br />

name of student) S/o/D/o Mr./ Mrs. /Ms. / Dr. _____________________________________,<br />

hav<strong>in</strong>g been admitted to <strong>HIHT</strong> <strong>University</strong>, have seen a copy of the UGC Regulations on<br />

Curb<strong>in</strong>g the Menace of Ragg<strong>in</strong>g <strong>in</strong> Higher Educational Institutions, 2009, (here<strong>in</strong>after called<br />

the “Regulations”) carefully read and fully understood the provisions conta<strong>in</strong>ed <strong>in</strong> the said<br />

regulations.<br />

2. I have, <strong>in</strong> particular, perused clause 3 of the Regulations and am aware as to what<br />

constitutes ragg<strong>in</strong>g.<br />

3. I have also, <strong>in</strong> particular, perused clause 7 and clause 9.1 of the Regulations and am fully<br />

aware of the penal and adm<strong>in</strong>istrative action that is liable to be taken aga<strong>in</strong>st me <strong>in</strong> case I<br />

am found guilty of or abett<strong>in</strong>g ragg<strong>in</strong>g, actively or passively, or be<strong>in</strong>g part of a conspiracy to<br />

promote ragg<strong>in</strong>g.<br />

4. I hereby solemnly aver and undertake that<br />

a. I will not <strong>in</strong>dulge <strong>in</strong> any behaviour or act that may be constituted as ragg<strong>in</strong>g under<br />

clause 3 of the Regulations.<br />

b. I will not participate <strong>in</strong> or abet or propagate through any act of commission or omission<br />

that may be constituted as ragg<strong>in</strong>g under clause 3 of the Regulations.<br />

5. I hereby affirm that, if found guilty of ragg<strong>in</strong>g, I am liable for punishment accord<strong>in</strong>g to clause<br />

9.1 of the Regulations, without prejudice to any other crim<strong>in</strong>al action that may be taken<br />

aga<strong>in</strong>st me under any penal law or any law for the time be<strong>in</strong>g <strong>in</strong> force.<br />

6. I hereby declare that I have not been expelled or debarred from admission <strong>in</strong> any <strong>in</strong>stitution<br />

<strong>in</strong> the country on account of be<strong>in</strong>g found guilty of, abett<strong>in</strong>g or be<strong>in</strong>g part of a conspiracy to<br />

promote, ragg<strong>in</strong>g; and further affirm that, <strong>in</strong> case the declaration is found to be untrue, I am<br />

aware that my admission is liable to be cancelled.<br />

Declare this _____ day of _________month of ________year.<br />

Signature of deponent<br />

Name:<br />

VERIFICATION<br />

Verified that the contents of this affidavit are true to the best of my knowledge and no part of<br />

the affidavit is false and noth<strong>in</strong>g has been concealed or misstated there<strong>in</strong>.<br />

Verified at __________ (place) on this ______ (day) of ______ (month) _________ (year).<br />

Signature of deponent<br />

Solemnly affirmed and signed <strong>in</strong> my presence on this the _________ (day) of ____ (month),<br />

_____ (year) after read<strong>in</strong>g the contents of this affidavit.<br />

NOTARY<br />

9


Appendix – I B<br />

AFFIDAVIT BY PARENT/GUARDIAN<br />

Before the Dean, Himalayan Institute of Medical Sciences, <strong>HIHT</strong> <strong>University</strong>,<br />

Swami Ram Nagar, Doiwala, Dehradun.<br />

1. I, Mr./ Mrs. /Ms. / Dr. ________________________________(full name of parent/guardian)<br />

father/mother/guardian of, Mr./ Mrs. /Ms. / Dr..__________________________________(full<br />

name of student) hav<strong>in</strong>g been admitted to <strong>HIHT</strong> <strong>University</strong>, have seen a copy of the UGC<br />

regulations on curb<strong>in</strong>g the menace of ragg<strong>in</strong>g <strong>in</strong> higher educational <strong>in</strong>stitutions, 2009,<br />

(here<strong>in</strong>after called the “ Regulations”), carefully read and fully understood the provisions<br />

conta<strong>in</strong>ed <strong>in</strong> the said regulations.<br />

2. I have, <strong>in</strong> particular, perused clause 3 of the regulations and am aware as to what<br />

constitutes ragg<strong>in</strong>g.<br />

3. I have also, <strong>in</strong> particular, perused clause 7 and clause 9.1 of the regulations and am fully<br />

aware of the penal and adm<strong>in</strong>istrative action that is liable to be taken aga<strong>in</strong>st my ward <strong>in</strong><br />

case he /she is found guilty of or abett<strong>in</strong>g ragg<strong>in</strong>g, actively or passively, or be<strong>in</strong>g part of a<br />

conspiracy to promote ragg<strong>in</strong>g.<br />

4. I hereby solemnly aver and undertake that<br />

a. My ward will not <strong>in</strong>dulge <strong>in</strong> any behaviour or act that may be constituted as ragg<strong>in</strong>g<br />

under clause 3 of the regulations<br />

b. My ward will not participate <strong>in</strong> or abet or propagate through any act of commission or<br />

omission that may be constituted as ragg<strong>in</strong>g under clause 3 of the regulations.<br />

5. I hereby affirm that, if found guilty of ragg<strong>in</strong>g, my ward is liable for punishment accord<strong>in</strong>g to<br />

clause 9.1 of the regulations, without prejudice to any other crim<strong>in</strong>al action that may be taken<br />

aga<strong>in</strong>st my ward under any penal law or any law for the time be<strong>in</strong>g <strong>in</strong> force.<br />

6. I hereby declare that my ward has not been expelled or debarred from admission <strong>in</strong> any<br />

<strong>in</strong>stitution <strong>in</strong> the country on account of be<strong>in</strong>g found guilty of, abett<strong>in</strong>g or be<strong>in</strong>g part of a<br />

conspiracy to promote, ragg<strong>in</strong>g; and further affirm that, <strong>in</strong> case the declaration is found to be<br />

untrue, the admission of my ward is liable to be cancelled<br />

Declared this_________ day of _______ month of ___________ year.<br />

Signature of<br />

deponent<br />

Name:<br />

Address:<br />

Telephone/Mobile No.:<br />

VERIFICATION<br />

Verified that the contents of this affidavit are true to the best of my knowledge and no part of<br />

the affidavit is false and noth<strong>in</strong>g has been concealed or misstated there<strong>in</strong>.<br />

Verified at _______ (place) on this the ______ (day) of ______ (month) ________(year)<br />

Signature of deponent<br />

Solemnly affirmed and signed <strong>in</strong> my presence on this the _____ (day) of _______ (month)<br />

________(year) after read<strong>in</strong>g the contents of this affidavit.<br />

NOTARY<br />

10

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