AFFIDAVIT

I, SAURODEEP BHATTACHARJEE, aged about 25 years, do hereby give the

following undertaking in the form of affidavit

1. That I have completed MBBS Degree at Dr. B.R. Ambedkar Medical College,
Bengaluru under Government Quota belonging to GM category pursuant to KEA
CET number CY025 and admission order bearing No. 1510004071 dated 29-06-2015
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2. That at the time of counseling, I had executed a bond in favor of Gov. as per section 3
of Karnataka Compulsory service training by candidates completed medical courses
act 2012 (hereinafter referred to as Compulsory Service Act) and as per the provisions
of rule 11 of Karnataka selection of candidates for admission to MBBS seats in
professional educational institutions Rules 2006 (hereinafter referred to as Admission
Rules) and based on my undertaking that “I shall serve the Government for a
minimum of one year after completion of course. If Government desires’’

3. I state that only after considering my undertaking that I shall render compulsory
service, in compliance of the section 3 of Compulsory Service Act and Rule 11 of the
Admission Rules Government seat was allotted to me at Dr.B.R. Ambedkar Medical
College, Bengaluru

4. I had given the bonds voluntarily and I am committed to discharge my obligations

towards the state in compliance of above said Undertakings

5. I state that I need my original marks card and other certificates which are in the
custody of RGUHS and I need NOC for registration in KMC for permanent KMC
registration

6. I am giving “ undertaking that I shall come and report to duty to discharge my

obligation towards Government when the Government directs me to report”

7. I am submitting this Undertaking Affidavit after understanding the consequences of

penalty clause in Compulsory Service Act and Admission Rules 2006

8. I further assure the Government that I shall discharge my obligation of Compulsory

Service as and when Government direct me to serve in public health sector failing
which I shall pay the penalty amount of Rs.10 lakhs to the Government or the
Government can recover the penalty amount by way of Revenue Recovery jointly or
severely from me and the surety

9. I have attached true copies of the following documents

a) Aadhaar Card
b) PAN card
c) Admission Order issued by the KEA
d) A copy of the bond executed by me as per the provisions of Compulsory Service
Act
e) A copy of the bond executed by me as per Rule 11 of Karnataka Selection of
candidates for admission to MBBS seats in professional Educational Institutions,
Rules 2006

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DETAILS OF SURETY

Name : Pratheek N
Father name : Narayanasawmi C
Age : 24 years
Address : Arahalli, Arehalli
Kolar, Karnataka – 563101
Aadhar No : 7964 4348 6361
PAN No : DEVPP6131P

Name : Kiran S
Father name : Srinivas
Age : 25 years
Address : No.5, 30th Main Road, Sakamma Layout, Nandini Layout,
Bangalore North, Bengaluru, Karnataka - 560096
Aadhar No : 6187 4557 4097
PAN No : EBXPK7879F

DEPONENT

Date : 25-05-2022

Place : Bengaluru

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