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JIPMER/DOCUMENT 2/Page 1 of 1 tokgjykyLukrdks Rrjvk;qfoZKku f'k{kk ,oavuqla/kkulaLFkku(fties j) (LokLF; ,oaifjokjdY;k.kea=ky; , HkkjrljdkjdsvkÄhujk’Vªh; egRodklaLFkku) /kUoUrfjuxj, IkqnqPpsjh605 006 nwjHkk’k /Tel: 0413-2272066 QS Dl/Fax: 0413-2272066 Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) (An Institution of National Importance under Ministry of Health & F.W., Government of India) Dhanvantari Nagar, Puducherry 605 006 Tel. : 0413-2272380-390 E-Mail : [email protected] UNDERTAKING I, Dr. …………………………………………………………………………………………………………………………. First Year Junior Resident of ……………………………………………………………………………………………….. Course at Jawaharlal Institute of Post-Graduate Medical Education and Research, Puduchery, do hereby undertake to complete the said course as per the requirements of the Institute. In the event of my leaving the studies in mid-term within one month of commencement of session, I undertake to pay to the Government a sum of INR 25,000/- (Rupees Twenty Five thousand only), if I discontinue the course after one month from the date of commencement of Session and within the First Academic Year, I undertake to pay to the Government a sum of INR 2,00,000/- ( Rupees Two Lakhs only) , if I discontinue the course in Second and Third Academic Year, I undertake to pay to the Government a sum of INR 5,00,000/- (Rupees Five Lakhs only). If I leave the course after 31-07-2015 (Thirty First July Two thousand and Fifteen), which is the last date for closing of the admission for July 2015 Session in the Institute, I, understand that I shall be debarred to appear for the Entrance Examination for PG(MD/MS) Courses of JIPMER for the next three Sessions. SIGNATURE OF THE CANDIDATE Date:

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JIPMER/DOCUMENT 2/Page 1 of 1

tokgjykyLukrdksRrjvk;qfoZKku

f'k{kk ,oavuqla/kkulaLFkku(ftiesj) (LokLF; ,oaifjokjdY;k.kea=ky; , HkkjrljdkjdsvkÄhujk’Vªh; egRodklaLFkku) /kUoUrfjuxj, IkqnqPpsjh605 006 nwjHkk’k /Tel: 0413-2272066 QSSSDl/Fax: 0413-2272066

Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)

(An Institution of National Importance under Ministry of Health & F.W., Government of India) Dhanvantari Nagar, Puducherry 605 006 Tel. : 0413-2272380-390 E-Mail : [email protected]

UNDERTAKING

I, Dr. ………………………………………………………………………………………………………………………….

First Year Junior Resident of ………………………………………………………………………………………………..

Course at Jawaharlal Institute of Post-Graduate Medical Education and Research,

Puduchery, do hereby undertake to complete the said course as per the requirements of the

Institute. In the event of my leaving the studies in mid-term within one month of

commencement of session, I undertake to pay to the Government a sum of INR 25,000/-

(Rupees Twenty Five thousand only), if I discontinue the course after one month from the

date of commencement of Session and within the First Academic Year, I undertake to pay to

the Government a sum of INR 2,00,000/- ( Rupees Two Lakhs only) , if I discontinue the

course in Second and Third Academic Year, I undertake to pay to the Government a sum of

INR 5,00,000/- (Rupees Five Lakhs only).

If I leave the course after 31-07-2015 (Thirty First July Two thousand and Fifteen),

which is the last date for closing of the admission for July 2015 Session in the Institute, I,

understand that I shall be debarred to appear for the Entrance Examination for PG(MD/MS)

Courses of JIPMER for the next three Sessions.

SIGNATURE OF THE CANDIDATE

Date: