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PROSPECTUS FOR ADMISSION INTO BASIC B.SC NURSING COURSE IN GOVERNMENT COLLEGE OF NURSING BERHAMPUR & PRIVATE COLLEGE OF NURSING RECOGNISED BY INDIAN NURSING COUNCIL FOR THE ACADEMIC SESSION 2016–17 Approved by Govt. in Health & Family welfare department Letter No: 12855/H. Dated 08/06/2016

Cost of application form & Prospectus: Rs.500/- (Rupees Five Hundred) only

1

Application form and Prospectus for admission in 4 years Basic B.Sc Nursing course for the academic session 2016-17 are available in the official website of the Directorate of Nursing, Odisha i.e. www.nursingodisha.nic.in (Click News & Events) during the period from 17.05.2016 to 03.06.2016. candidates seeking admission for the course at Govt. College of Nursing, Berhampur & Private College (recognized by the Indian Nursing Council) in the state of Odisha may apply in the prescribed application form within the stipulated time .

For any query contact:- Tel No-0674-2393840

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INDEX S.NO

CONTENT

PAGE NO

I

Admission Calendar

4

II

General information

4

III

Eligibility criteria

5

IV

Procedure for filling of application form

5-7

V

Merit list

7

VI

Counseling overview

8

VII

Selection Procedure and reservation Policy

8-9

VIII

Fee structure

9-10

IX

Post admission

10-11

Annexure I

Application Form

12-13

Annexure II

List of Govt. and Private colleges and the no.of seats 14

Annexure III

Permanent resident certificate

15

Annexure IV

SC/ST certificate

16

Annexure V

Certificate for Ex-service men/Service men

17

Annexure VI

Self Declaration by Parent/ Gurdian

18

Annexure VII

Medical Certificate

19

Annexture VIII SBI Challan Form

20

3

I.

ADMISSION CALENDAR

1

Availability of application form & Prospectus in official website www.nursingodisha.nic.in.

Dt.22.06.2016 to 15.07.2016

2

Last date of receipt of Application

Dt. 18.07.2016 by 5 P.M

3

Dates for complying the Deficiencies

Dt. 08.08.2016 to 10.08.2016

4

Expected date of declaration of merit list in the web-site

Dt. 27.08.2016

5

Expected Date of Counseling & deposit of course fee.

Dt. 26.09.2016 to 27.09.2016

II.

GENERAL INFORMATION

-

The duration of the course is 4 years.

-

All seats in (Govt. college of Nursing, Berhampur & 85% Govt seats of private Colleges) will be filled up from the Central merit list.

-

Private institutions will fill up 15% seats under management quota following the minimum eligibility criteria of Govt. of Odisha and INC New Delhi.

-

If seats (out of the 85% Govt quota seats of the private institutions) remain vacant, then the private institutions may be allowed to fill up those seats from the common merit list.

-

Private Nursing institutions recognized by the Indian Nursing Council as on 31.08.2016 will be allowed to admit candidates for the academic session 2016-17.

-

Both Female and Male candidates are eligible to apply. (10% seats reserved for male candidate.)

4

III.

ELIGIBILITY CRITERIA Candidate must :

Be of minimum 17 years of age as on 31.12.2016.



Have passed 10+2 or equivalent examination with Science (Physics, Chemistry & Biology) from CHSE, Odisha or any other board or Council or University equivalent thereof. Have passed 10+2 examination in Science ( physics, chemistry & Biology) conducted by National Institute of Open School with 45% marks are also eligible to apply.





Have aggregate mark of minimum 45% in the above qualifying examinations.



For S.C/S.T candidates the above qualifying mark is 40 % .



Have passed odia upto ME standard. For Candidates to be admitted in (Govt. /85% Govt. quota seats in INC recognized private) institutions .



Be either domicile/ permanent resident /native of Odisha but currently residing outside Odisha ( candidate seeking admission in Govt College of Nursing, Berhampur and 85% of seats ( Govt quota) in Private INC recognized institutions) (Candidates from other states are also eligible to apply and take admission under 15% management quota in private nursing institutions ( Recognised by the INC).)

IV.



Be medically fit to undergo the course.



Locomotor disability of lower limbs between 40% to 50% only will be taken into consideration for Physical handicapped category.

PROCEDURE FOR FILLING UP AND SUBMISSION OF APPLICATION.

   





All applicants are advised to go through the Prospectus thoroughly before filling up the application form. Candidate must apply in the prescribed application form along with requisite fees and self attested photocopies of the documents/testimonials.. The application form must be filled up by the candidate in his/her own handwriting and signed at the appropriate column. Incomplete Application will be summarily rejected . application form Overwriting/cutting are also liable to rejected.

If ineligibility of a candidate is detected at any stage before or after publication of merit list/ counseling/Admission, his/her candidature/admission will be cancelled without any notice. If any document/certificate submitted separately at later stage should bear the following title: "Registration Form No....... for Basic B.Sc Nursing Selection, 2016". 5

In case any candidate is found to have furnished false information or certificate etc. or is found to have withheld or concealed any information in his/her application, he/she will be debarred from admission. 

  

It is the responsibility of the candidate to ensure that correct details including address, Email Id, contact number is filled in the Application Form. The Convenor will not be responsible for any loss in transit or for incorrect address given by the applicant in the Application Form. Please make the payment as directed to avoid rejection on account of non-payment. No candidate is allowed to register for more than one application. The following Documents are to be furnished by the candidate along with the application form a) Self-attested photocopy of 10th (HSC) or equivalent examination mark sheet& pass certificate. b) Self-attested photocopy of 10+2 mark sheet & pass certificate issued by CHSE, Odisha or equivalent thereof. c) Self-attested photocopy of conduct /character certificate from the head of the institution last attended. d) Colour passport size photograph (5cmx7cm approximately) self attested on front side should be affixed at the space provided in the application form. e) In case of SC/ST candidates, self-attested photocopy of the caste certificate from the competent authority (Refer Annexure -IV) f) Self-attested photocopy of the resident certificate/nativity certificate/from the competent authority (Refer Annexure-III). g) Self-attested photocopy of physically handicapped certificate from the competent authority (For physically handicapped candidates.) h) Self-attested photocopy of the certificate issued by the Rajya Sainik Board. (candidates claiming seats reserved for Children of Ex-Serviceman & Serviceman Refer Annexure V) i) Self attested photocopy of Green Card issued by the Chief District Medical Officer. ( Candidates claiming seats reserved under Green Card quota) The name and Date of birth in green card should match with the name and Date of birth mentioned in the HSE/equivalent certificate. Any difference regarding this should be supported by an affidavit duly sworn in before the executive magistrate.

j) Original challan deposit slip of SBI Challan of Rs.-500/- towards application fees(Refer Annexure –VIII.) 6

k) A self-addressed envelope of size 23cmx10cm (affixing postal stamp Rupees 39/-) for despatch of intimation letter. 

Candidates are required to send application along with required documents which should reach the “Convenor, Basic B.Sc Nursing Selection Committee and Deputy Director Nursing, Odisha, O/O the Directorate of Nursing, Heads of Deptt. Building, Bhubaneswar, Khorda, Odisha, Pin – 751001 on or before 18.07.2016 . 5 PM. a. Applicant has to send application through Regd.Post/Speed Post. The envelope containing the application shall be prominently superscribed “Application for Admission into Basic B. Sc. Nursing Course 2016 – 2017”. b. Applications received after the due date shall be summarily rejected. c. Address of the candidate must be written correctly on the acknowledgement card and attached to the application form in the envelope.

V.

d. The cost of application fee is non-refundable . MERIT LIST



The merit list will be prepared on the basis of career marks.



For career marks, 50% of the aggregate marks secured in HSC/10th & 50% of the aggregate marks secured in Physics, Chemistry, Biology & English in 10+2 /12th examination will be taken together.



For example: (if in 10th examination 60% mark secured and in 10 +2 (Physics+ Chemistry+ Biology+ English = 50% of mark is secured then career marks will be 30 + 25 =55 marks )



In case of candidates having equal marks in aggregate “on the above career marking”, inter-se-merit shall be decided as follows. 1st.

According to the total marks secured in Biology at the qualifying examination.

2nd. In case of a further tie, candidate senior according to the date of birth will be considered . 

Eligible candidates as per their merit will be directed to appear before the Selection Committee on the schedule date, time and venue for counseling and admission. The merit list will be prepared separately for the following category o o o o o o

SC ST Physical Handicapped Green card holder. Ex-Serviceman Common merit list

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VI.

COUNSELLING OVERVIEW



The Date, Time & Venue of the counseling will be notified in the official website of the Directorate of Nursing (www.nursingodisha.nic.in ).



Intimation letter will be also sent to the candidate in his/her address.



In case the candidate fails to receive the intimation by post/ download from the website, he/she may collect a copy from the Convenor ( Dy. Director Nursing) in any working day between 10- 5 P.M during the pre-counselling period.



Candidates are required to attend counseling on the scheduled date and time. No representative in his/her favour for the purpose shall be entertained .



Counseling and admission against reserved category will be done at beginning.



If a Candidate fails to attend counseling on the scheduled date will not be allowed for admission during the session 2016-17.



Once the candidate has opted for a seat in any institution, he/she will not be allowed to change the option.

Documents to be produced by the candidate at the time of counseling and admission. 

All the documents in original mentioned in page no:6 would be verified during the counselling with regard to the facts and figures furnished in the application in support of her / his candidature. Claims for admission would be rejected if the original certificates and documents are not submitted by the candidate at the counselling spot. Undertaking for extension of time to submit the original certificate / certificates and document / documents will not be entertained under any circumstances.

N.B: Candidates are required to submit CLC/TC and Registration certificate/Migration Certificate during the time of counseling. Incase of non availability of these aforesaid documents the candidate shall submit an undertaking that he/she will submit the same at the concerned institution during the time of reporting . 

Undertaking as per Appendix – VI of this Prospectus, signed parent/husband/guardian/ local guardian of the candidate shall be submitted.



Applications for change of training institution during the training period are not permissible at any circumstance.

NOTE. 1

the

Claims for admission shall be rejected if the original certificates/documents are not submitted by the candidate at the counseling spot. No undertaking in this regard will be accepted .

VII. SELECTION PROCEDURE AND RESERVATION POLICY

(Common to all college of Nursing): a)

by

22.5% for ST 8

b)

16.25% for SC

c)

3% each for PH

d)

5 % GC

e)

3% for Children of Service men & Ex-Service Men

f)

10% reservation for male candidate out of the total seats as per the reservation policy.

N.B: Seat inter-convertibility:  In case the seats reserved for SC category will not be filled up because of non availability of candidates belonging to the particular category the vacant seats will be filled up by the candidates belonging to Scheduled Tribe category and vice versa.  In case candidates do not qualify from the SC/ST category, vacant seats will be filled by the candidates from the general category.  Similarly, in case the seat remains vacant against any reserved quota then these seats shall be filled by the candidates from the general category. NOTE. I

All reserved category candidates who qualify in the common merit list can attend the counselling for unreserved category seats and exercise her/his option. Her/His candidature will be considered as per the position in the common merit list.

VIII. FEE STRUCTURE The following fees are to be deposited at the time of admission into 1st Year/2nd Year/3rd year /4th year Basic B. Sc. Nursing Course.

Fee for Government College of Nursing: Fees

1st Year

2nd Year

3rd year

4th year

Admission /Tuition Fee

Rs.14,000/-

Rs.14,000/-

Rs.14,000/

Rs.14,000/

Caution Money(Refundable) TOTAL

Rs.1,000/-

-

-

-

Rs.15,000/-

Rs.14,000/-

Rs.14,000/-

Rs.14,000/-

Besides the above, the hostel fees, electricity charges, University registration & examination fees & other college/institution dues etc shall be paid extra.

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Fee for 85% of seats (Government quota seats) at Private Colleges of Nursing: Fees

1st Year

Tuition Fee/Admission Rs.42,000/Fees TOTAL Rs.42,000/-

2nd Year

3rd year

4th year

Rs.42,000/-

Rs42,000/-

Rs.42,000/-

Rs.42,000/-

Rs.42,000/-

Rs.42,000/-

Besides the above ,the hostel fees, electric charges, University registration & examination fees & other college/institution dues etc shall be paid extra.

IX.

POST ADMISSION. a. STIPEND AND SCHOLARSHIP



Candidates admitted in Govt. College of Nursing . Berhampur will be paid stipend @Rs1500/- P.M during internship.



SC / ST candidates for admission into B.Sc. Nursing Course in private recognized institutions in the State will get Scholarship by NHM, Government of Odisha under Public-Private Partnership (PPP) scheme titled “Swasthya Sebika Nijukti Yojana” ,Subject to approval of competent authority /funding agency as under:-

-

Partial Scholarship as tution fees to SC/ST candidates in non-KBK districts for B.Sc. Nursing. Per candidate @ Rs.15,000/- per annum.

-

Full Scholarship as tution fees to SC/ST candidates in KBK + districts for B.Sc Nursing. Per candidate @ Rs.50,000/- per annum.

-

Sponsored SC / ST candidates have to execute a bond with Government which will be provided during admission subject to provision of funds by the appropriate authority.

b. HOSTEL ACCOMMODATION: 

Hostel accommodation shall be provided to the candidates at Govt. College of nursing by the Principal as per merit and subject to availability.



There is no provision of hostel for male candidates in Govt. College of Nursing and they are required to stay outside in their own arrangement.



Hostel provision for male candidates of Private Nursing Colleges is optional.



In exceptional circumstances, outside hostel accommodation for married women 10

candidates will be considered by the Director of Nursing, Odisha keeping in view the genuineness of the case. c. UNIFORM : Female candidates have to wear bottle green Saree / Salwar and Punjabi during field duty, and white colour Saree, Blouse / Salwar and Punjabi with white Coat during clinical duty. Male candidates have to wear bottle green trouser and shirt during field duty and white colour trouser and shirt with white coat during clinical duty.

d. DISCIPLINE:  

Candidates got admitted should abide by the Rules and Regulations of the College, Hostel & concerned University/examining body. Those found disobeying the Rules and Regulations shall be debarred from the Hostel and College without any notice. AS PER DIRECTION OF HONOURABLE SUPREME COURT OF INDIA PASSED IN SLP (C) No.24295/2004, SLP No.14356/2005, WPC No.173/2006 AND SLP (C) No.24296 – 24299/2004.

IF ANY INCIDENT OF RAGGING COMES TO THE NOTICE OF THE AUTHORITY, THE CONCERNED CANDIDATE SHALL BE GIVEN LIBERTY TO EXPLAIN AND IF HER / HIS EXPLANATION IS NOT FOUND SATISFACTORY, THE AUTHORITY WOULD EXPEL HER / HIM FROM THE INSTITUTION. Affidavit (1) by the candidate (2) by the parent shall be taken as per the circular No.22-1 O(Web)-INC (Part) dated 14th May 2013.

o In case any dispute in respect of the stipulation in this prospectus and admission of students ,the interpretation and decision of the admission committee shall be final and bounding. o In case of legal disputes the counter/P.W(c) will be filled by the convener on behalf of selection committee/Govt.

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ANNEXURE- I

APPLICATION FORM FOR BASIC B. Sc. NURSING COURSE 2016 - 2017 Note: To be filled in by candidate’s own handwriting (1)

FULL NAME OF THE CANDIDATE AS RECORDED IN THE H.S.C.E OR EQUIVALENT EXAMINATION.

(In block (2)

Sex

Affix a passport size photograph attested by a letter) …………………………………………………………………………… Gazetted officer on the :……………………… front side.

(3) CATEGORY CLAIMED – GENERAL / S.C./ S.T./ P.H./ Green Card Holder / (Put Tick  mark whichever is applicable). Ex – Servicemen or Servicemen

(4)

Date of Birth …………………………………………………….. (As recorded in H.S.C. or equivalent examination)

(5)

Age as on 31.12.2016 of the year of Admission …………………………………………

(6)

Nationality ……………… (7) Married / Unmarried ……………..(8) Religion ………….

(9)

Educational Qualification …………………………………………

(10)

Permanent home Address:Village / Town …………………………………………………………….. P.O - . ………………..………….Police Station ………………………… Tahasil ……………………………………………………………..………. Dist. …………………………State: ………….. Pin …………………… (11) Present Address …………………………………………………………………….………………………………. (For correspondence) …………………………………………………………………… …………………………………………………………………….. Personal Contact no ……………………………Email Id……………………………………… (12) Full Name of Father / Husband / Guardian (if father is dead) ……………………………………………………………………… Occupation …………………………………………………………………………. Address …………………………………………………………………………..… ……………………………………………………………………………… (13)

Academic Details : Name of the Examination (+2) Science or its equivalent………………………… Name of the University / Council / Board …………………………………………

(14) Sl No.

Name of the Examination

1.

HSC or equivalent

Mark Without Ext. Opt.

12

Percentage without Ext. Opt.

50% of the mark secured

(15)

(16)

Mark secured in 10 + 2 Science Examination SUBJECT TOTAL MARK ENGLISH PHYSICS CHEMISTRY BIOLOGY GRAND TOTAL

PERCENTAGE

Documents and Certificates enclosed (Put Tick  mark) (i)

(ii)

Self Attested copy of H.S.C. or equivalent examination Certificate issued by Board of Secondary Education or equivalent Board as evidence of age. Self Attested true copy of the 10th Pass Certificate & mark sheet.

(iii)

Self Attested true copy of mark sheet & certificate of qualifying examination (10+2) issued by the C.H.S.E. / Board / University. (iv) Self Attested copy of the conduct / character certificate issued by the Head of the Institution last studied. (v) Self Attested copy of certificate in support of category claimed (S.C./S.T. /P.H./Ex-Servicemen or Servicemen/Green Card Holder) (vi) Self Attested copy of Residential / Nativity for candidate who claims as permanent resident of Odisha. (vii) A self addressed envelope of size 23 cm x 10 cm for dispatch of intimation letter through Regd. Post (with 39/- Rupees postage stamp). (viii) One attested copy of recent passport size photographs affixed in the space provided in the application form (ix) Original Department’s slip portion of SBI Challan of Rs.500/-

Yes / No

Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No

I declare that the above statement of particulars furnished by me are true in all respect and as such, I undertake that if subsequently, I will be found to have given wrong information with regard to the marks, certificates and documents produced by me in connection with my admission, then my name will be immediately removed from the College in addition to whatever legal action that be taken against me, I agree to abide by the rules of the College / Hostel and pay all fees and deposit all other dues as laid down in the College. I certify that I have not been prosecuted or convicted for any criminal offence involving moral turpitude.

Date -

Full Signature of the Applicant Countersigned by Parents / Guardian / Husband Name …………………………………. Date :………………….. 13

ANNEXURE- II All the Nursing institutions (Govt. & Private) having INC recognisation as on date 31.08.2016 will be allowed to admit candidates for the academic session 2016-17 . For more information check on INC website link: www.indiannursingcouncil.org/Recognized-Nursing-Institution.asp?show=bsc

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ANNEXURE – III PERMANENT RESIDENT CERTIFICATE FOR BASIC B.Sc. NURSING COURSE 2016 - 17 Office of the ………………..…………….……………………………………………….. Miscellaneous Certificate Case No.……………………………………………... of 2016 This is to certify that Sri / Smt. / Miss / …..…………………………………………….… Son / Daughter / Wife / of Sri ………………………………………………………… is a native of the district of ……………………………………………………………….. in the State of Odisha and he / she belongs to P.S. ……………………………………….. Tahasil ……………………………………………….. The certificate is being granted only for the purpose of Basic B.Sc. Nursing Course – 2016-17 Odisha.

Full Signature of the applicant

Signature of Revenue Officer Date –

Round seal of the Office

Designation (with seal of officer)

NOTE :- 1. Revenue Officer means the Chief Officer in charge of Revenue Administrative in the District, Sub-Division of Tahasil&includes Additional Magistrate and Additional Tahasildar.

15

ANNEXURE – IV

SC/ST CERTIFICATE BY BIRTH FOR BASIC B.SC NURSING COURSE 2016- 17

This is to certify that Sri / Smt. / Miss …………………………………………………………… Son/ Daughter / Wife of Sri ……………………………………………………………………… of Village / Town ………………………………………………………………………………… P.S. ………………………………………………. Tahasil ……………………………………… in the District of ……………………………………………………… in the State of Odisha belongs to the ……………………………………. Caste / Tribe which is recognized as Scheduled Caste / Tribe and under Constitution (Scheduled Caste) order 1950 / the Constitution (Scheduled Tribe) order, 1950 as amended by the Scheduled Castes and Scheduled Tribes (Amendment) orders Act 1976. The place of birth of Sri / Smt. / Miss ……………………………………………………….. is of Village / Town ……………………………………………………… P.S. ………………………………………Tahasil ………………………………………………. in the District of ……………………………………. of the State of Odisha.

Full Signature of the applicant

Signature of Revenue Officer Date –

Round seal of Office

Designation (with seal of officer)

16

ANNEXURE – V CERTIFICATE OF EX-SERVICEMAN / SERVICEMAN

1.

Name of the ex-Serviceman / Serviceman

:

2.

Permanent address as per service records

:

3.

Rank in Defense Service

:

4.

Last place of posting (in case of Ex-Servicemen)

:

5.

Present place of posting (in case of serving personnel)

:

6.

Full name of the candidate

:

7.

Relationship of the ex-Serviceman / Serviceman with the candidate

:

Full Signature of Station Commander / Officer Commanding / Officer-in-Charge / Secretary, Zilla / RajyaSainik Board

Full signature of candidate’s Parent Designation with Seal of Office Date -

17

ANNEXURE – VI SELF DECLARATION BY PARENT /GUARDIAN

(To be submitted by the selected candidates at the time of admission) I Sri /Smt. ……………………………………………………………………. Name of the Local Guardian (Address of the Local Guardian) ………………………………………………. …………………………………………………………………………………………………… …. Undertake to act as the Local Guardian of Miss / Smt./Sri ………………………………… Daughter / Wife / Son/Ward of Sri / Smt. ……………………………………………………. ………………………………………… During her / his period of study in the College of Nursing, …………………………………………………... ………………………………………. I also undertake to act on behalf of the parents / husband of the said candidate during the period of study in the College of Nursing, ………………………………………... for which I have been empowered by the parent / guardian / husband of the said candidate.

I further undertake to take custody of the above candidate if and when required by the College authorities and to ensure that she / he maintains the academic discipline and good conduct during the period of study in the aforesaid institution.

Place - ……………………………..

Signature in full of the Local Guardian

Date - ……………………………… ATTESTATION BY PARENT / HUSBAND / GUARDIAN The above undertaking has been signed in my presence, I empower Sri / Smt.…. ………………………………………………………………………..to act as Local Guardian of my daughter/wife/Son/ Ward, Miss/ Smt./ Sri…………………………………………….. during the period of her/his candidateship in the College of Nursing ……………………….. .. ………………………………………………………… Place - …………………………….

Signature in full of the Parent / Guardian / Husband

Date - ……………………………… Signature in full of the Candidate 18

ANNEXURE-VII

MEDICAL CERTIFICATE CERTIFICATE OF PHYSICAL FITNESS IN RESPECT OF SELECTED CANDIDATES FOR ADMISSION INTO BASIC B.SC NURSING COURSE FOR THE SESSION 2016-17 Name of the Candidate in full ………………………………………………………………… Age ………………… , Sex – Female , Height …………………. , Weight …………………. , Heart …………………. , Eye ………………… , Teeth …………..……, Liver ………..…… , Lungs ………………… , Spleen …………………….. ,Blood Pressure …………..………… , Blood Group …………………… Please indicate if Pregnant ………………………………. Date of L.M.P. …………………………………………….. Previous Medical History, if any ……………………….. Personal Remarks of Identification

1. …………………………………………………………………………………………… 2. ………………………………………………………………………………………… I certify that I have examined the above named candidate and cannot discover that she has any diseases, constitutional weakness or bodily infirmity and I consider that the candidate is physically and mentally fit to undergo B.Sc nursing course. SIGNAURE OF THE CANDIDATE

Designation – Date -

NOTE :-

This certificate is to be detached for submission only by the selected candidates on the date of counselling.  This certificate must be obtained from the Got medical officer not prior to 15 days of the counselling date.

19

ANNEXURE –VIII SBI CHALLAN BANK’S SLIP STATE BANK OF INDIA (POWER JYOTI ACCOUNT) CHAIRMAN, BASIC B.Sc. Nsg. SELEC. COMM. & DIRECTOR NURSING,ODISHA ACCOUNT No. 30760841412 Name of candidate:-

CANDIDATE’S SLIP STATE BANK OF INDIA ( POWER JYOTI ACCOUNT) CHAIRMAN, BASIC B.Sc. Nsg. SELEC. COMM. & DIRECTOR NURSING,ODISHA ACCOUNT No. 30760841412 Name of candidate:-

DEPARTMENT’S SLIP STATE BANK OF INDIA (POWER JYOTI ACCOUNT) CHAIRMAN, BASIC B.Sc. Nsg. SELEC. COMM. &DIRECTOR NURSING,ODISHA ACCOUNT No. 30760841412 Name of candidate:-

Branch Name Branch Code Amount Rs. In words ………………………..………Rupees only Journal No. .................................................. (To be filled by Bank)

Branch Name Branch Code Amount Rs. In words……………………………..Rupees only Journal No. .................................................. (To be filled by Bank)

Branch Name Branch Code Amount Rs. In words……………………………..Rupees only Journal No. .................................................. (To be filled by Bank)

Sign. Candidate

Sign. Candidate

Sign Bank Off.

Sign. Bank Off.

Sign. Candidate

Fees remitting Branch may collect Rs. 50/-( Rupees Fifty) only towards non-home charges from the remitter separately

21

Sign. Bank Off.

22