ANNEXURE – I
All candidates should furnish a certificate from the employer under whom the
candidate is presently working in the prescribed form as the situation may be.
• FORM A – Endorsement by the head of the institute under whom the candidate
is presently working/studying with, in case of candidates seeking admission
under service quota.
• FORM B – Endorsement by the head of the institute under whom the candidate
is presently working with, in case general candidates.
• FORM C -- Declaration by candidate in case the candidate is not currently
employed
• FORM D – Course completion certificate to be produced by candidates who have
not completed their MD/MS/DNB course
• FORM E – Endorsement by the head of the institute under whom the candidate is
presently working/has worked with, in case of candidates seeking marks as per
Annexure II, Part III (work experience in Surgical/Medical/Pediatric Oncology)
FORM A NO OBJECTION CERTIFICATE
(ON THE LETTERHEAD OF THE INSTITUTE)
Dr.____________________________________________________________________
is working as ____________________________________________________ with
effect from _____________________________________. He / she is a
permanent/temporary employee of
the__________________________________________________________
_______________________________________________________________________.
The information furnished by the candidate in his application form is correct. I have no
objection to his / her seeking admission to MCh/DM course at the Regional Cancer
Centre, Thiruvananthapuram. He / She will be relieved from his post for a period of three
years for undergoing the course if selected and admitted to the course at RCC and his/her
salary/stipend will be paid by his employer during the three year period of course.
Name of the Employer: ____________________________________________________
Name of the Institute: ____________________________________________________
Place: Signature of the Employer
Date: Seal
FORM B NO OBJECTION CERTIFICATE
(ON THE LETTERHEAD OF THE INSTITUTE)
Dr._____________________________________________________________________
is working as ____________________________________________________ with
effect from _____________________________________. He / she is a
permanent/temporary employee of the
________________________________________________________
_____________________________________________________. The information
furnished by the candidate in his application form is correct. I have no objection to his /
her seeking admission to MCh/DM course at the Regional Cancer Centre
Thiruvananthapuram. He / She will be relieved from his post for a period of three years
for undergoing the course if selected and admitted to the course at RCC.
Name of the Employer: ____________________________________________________
Name of the Institute: ____________________________________________________
Place: Signature of the Employer
Date: Seal
FORM C
DECLARATION BY THE CANDIDATE
I declare that all the information furnished in the application form by me is correct and
true. I declare that I am not currently employed/studying in any institution/hospital in
either Government/public/private sector and incase of my selection for the course there
would not be any issue of my getting relieved from any post held by me.
Place: Signature of the candidate
Date: Name of candidate
FORM D COURSE COMPLETION CERTIFICATE
(On the letterhead of the institute/department)
This is to certify that Dr.__________________________________________________________
is undergoing his postgraduate course (MD/MS/DNB) in the Department of
____________________________________________________________________________ at
______________________________________________________________________________
______________________________________________________________________________
and is likely to complete his course by______________________________(DD/MM/YYYY)
Name of the Institute: ___________________________________________________________
Place: Signature of the principal
Date: Seal
FORM E EXPERIENCE CERTIFICATE
(On the letterhead of the institute/department)
This is to certify that Dr.__________________________________________________________
is working/has worked in the Department of Surgical/Medical/Pediatric Oncology at the
______________________________________________________________________________
_______________________________________________________as_____________________
______________________________________________________________________________
_____________________________________________for a continuous period with effect from
___________________________________to
_________________________________________
I have no objection in his / her seeking admission to the MCh/DM course at the Regional Cancer
Centre, Thiruvananthapuram. His/Her conduct during the period mentioned above has
been_________________________________________________________________________.
Name of the Employer: __________________________________________________________
Name of the Institute: ___________________________________________________________
Place: Signature of the Employer
Date: Seal
ANNEXURE – II MARKS PROCESS
Part I - THEORY - 100 marks
MCQ paper containing 100 Questions (1 mark for correct answer, minus half mark for wrong
answer). No marks will be awarded for unanswered questions or multiple responses. Candidates
will be short listed purely on the basis of theory marks. The number of candidates short listed
will be four times the number of seats available.
Part II - INTERVIEW (VIVA) - 20 marks
Candidates will be assessed about clinical procedures, skills, aptitude, commonly practiced
protocols, current evidence and recent advances in the speciality.
Part III - PRIOR ACADEMIC RECORDS - 10 marks
Prior academic performance /experience will be awarded credits subject to a maximum of 10
marks.
1. Publications in Indexed Medical Journals only (Please submit Xerox copy of publication)
One mark/ publication subject to a maximum of 05 marks
2. Work experience in Surgical/Medical/Pediatric Oncology (Maximum 05 marks)
Six months to less than one year – 01 mark
One year or more – 02 mark/ year
Only continuous experience in an exclusive Surgical/Medical/Pediatric Oncology department
will be considered for this purpose. No marks will be given for experience of less than 6 months
and for discontinuous period of experience. Candidate needs to produce a certificate to prove the
experience in Surgical/Medical/Pediatric Oncology Department as in the Form E of
ANNEXURE I.
ANNEXURE III
AUTHORIZATION LETTER Submitted by an Authorized representative
[See Clause VII (g) of the prospectus]
I, ______________________________________________________(name of candidate)son/daughter of Shri./Smt. _________________________ having Roll No. _______________ in the RCC, Thiruvananthapuram Post graduate Superspeciality Entrance Examination 2016, with Rank _____________, do hereby authorize Shri/Smt __________________________________________________________________________________________________________________________________________________________________________________________
____(name and address of the person being authorized) to represent me to report at the allotment venue for admission to Surgical/Medical/Pediatric Oncology course in 2016. The signature of the person authorized is attested below by a Gazetted Officer.
Signature of the Candidate:
Name of the Candidate: ___________________________________________________
Address: ______________________________________________________________
_____________________________________________________________
_____________________________________________________________
Name and Designation of the Gazetted Officer
Office Seal
Signature of the Authorized Representative:
ATTESTED:
SIGANTURE OF THE CANDIDATE
Candidate to sign over the photograph
UNDERTAKING I, undertake that the decision taken if any, by my authorized representative at the allotment venue shall be binding on me and I shall not have any claim whatsoever, other than the decision taken by my authorized representative on my behalf. Place : Date :
Signature of the Candidate Note: An authorized representative attending counseling, 2016 must bring a photocopy also of the filled up form. The same will be returned to the representative with the seal of the Director RCC. This copy of the filled up form having the seal of the Director RCC can be used in lieu of authorization letter during subsequent appearances.
ANNEXURE IV Format for appeal regarding mistakes in questions / answers
Use separate sheets for each question/answer appeal
Incomplete appeals will be rejected
Name of the candidate
Admit Card Number
Speciality applied for