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NMC- Faculty Declaration Form (2021-22)v.l.l

Faculty Declaration F'orm (F or AY 202'1, - 22)


Name of the College: NARAYANA MEDICAL COLLEGE, NELLORE' AP - 524003

Assessment date Remrrks and Signature of Assessor


Accepted Yes / No
Assessor's name

Notc: It isthc rcsponsibility of lhc Dc.n to cnsurc lhll lh. lubmittrd Dcclontion form is ONLY oft Faculty mcmbcrwhois a full-time
cmployc€ hr3 notappcrrcd for tslattmcnt in rnyothcr col *d in snv c{pacitv dudn(' stalcd dcad,r
L Name of Faculty: Dn' 'ET--'ai"jiltlt
2. Age & Date of birth: 4Rtvearg 27 /--P3_ / lq) 3 flIlr
3. Photo ID submitted: PAN Card/Aa&i Card/Voter IDlPasspo copy
Number:
-Itoo Gt't o LSc+
QoVT (NDrA it
Issuing Authority:
Not!:
(D
OF
Declaration forms without r valid govemmcnt issucd Photo lD will NOT bc acceptcd.
I
(ii) It is msodstory to produc. Original ccrtilicstcs at the time ofverification.
(iii) Only crrtilicatevdocumentycenificd t8[slations h thc English langu8ge will bc
mmEtnrua MEDIOAT COTI-EGE
4. Present Designation: P o €-J.s sR H CHINTH AREDDYP ALEM.
4003
AN
a. Appointrnent order: Certified copy of order at this insti tute attached: Rttc DESH, INDIA
b. Department: o o0&eprcr
c. College/Institute: NARAYANA MEDICAL COLLE
d. City/District: CHINJHAREDDYPALEM,NELLORE
e. Appointment: (i)RegUiar/ContractuaVAd-hocbasis
(ii) Full li'me /Part time
(iii) With Private practice / Without Private practice
f. Date of appearance in last MCt/ltlMC assessment:
i. UG / PG / Any other: oY- Oz -2\
ii. Name of College: DARhYflNh I0cOlcAL c-sLL€q6: NFt-uoAe
iii. Whether appeared aud aCcepted at the same Coil%r:
%47 No ,
-
iv. Whether appeared aud accepted for tho same designation: YEs / No
v. Whether retired from Govemment Medical yes Collele:
Nb"
vi. Ifyes, designation at the time of retirement:
5. Complete Residential Address of the employee:
a. Present: L L .Lo N
.f

(_ L 'os
b. Permanent:

ovt li
6. Copy of Proof of Residence submitted and original verified: l-.-{es / No
(Only copi* of pas sportlAddczrdwoter lD/Passport/Etcctricity bitylsndline Phone bill will be corsidered)

7. Contact details:
a. Offrce telePhone with STD code: 086r-23179 63-64

b, Residence telephone with STD code:

c. Mobile Phone Number: 9?oac t6bg 1


d. Email adC.ress: .{r66 Lo

8. Date ofjoining the present institution: /o IL sls


9. Joining report veritled / attached 1-.Yes / No

the Facu I'y


NA @m66t
Si THA EODYP ALEIM,
NELLOFE 524M3.
ANDHRA PFADESH. INDIA
NMC- Faculty Declaration Form (2021-22)V.l.l ta
Yes / No.
10. Have you attended the'Basic Course Workshop' for training in MET:
If Yes, give details (strike out whichever is not applicable):
Yes /No.
a. at MCVNMC Regional MET Centre: Yes /Nor
b. at your college under Regional Centre observership:
i.Name of Observer:
I 1. Educational Qualifications:
Registration nurnber Name of State
Degree Year Name of College & UniversitY with date of Medical council
re on

8i &vo j uI, Uf.af.-l) 6 aost


c
MBBS tqqT cp)lce^ kolo ko*nqhl" 16.?. )-s,o ftPfY)
Bo*pol of( \) fl tVe{ Xt 11
zulr,i ,vrqtr-'ot r0J-J cJl? ( E63'
6
f ruc
>6 ''l ' Lo, o
MD/MS ,A
LOo\ Cluidonn bn*v
Anrrqroqlqi Ur i uavrt"ly

DM/MCh

PhD

a. MD/lr4S subject: s lc
b. DM/1\4Ch subject:
c. PhD subject:
Note: For PC & Post PG qualifications, particulars of Registration of Additional Qualificationcertificates
are to be furnished for them to be accepted. Strike out whichever section is not applicable.
12. Copies of educational qualifications:
a. Copies of MBBS & Pg_Deglee certificates verified and attached dTtNo
b. Copies MBBS & P9.pegree Registration verified and attached: Yes / No
13. Details of expen ence till date:

Designation* Department Institution From To Total


Rqlah Hurtrah Toczo 7oo3 3vr
o f t\o/oci,,y NoA'' al coll e1e, c h,.{',.n} atafi\
Junior Resident

Senior Resident

Tutor

Nolah wtufuoh tu.J r^lltr


L9.of,sl I lfrl) lfa
l,3.,o,sf o+, 03 , b7
Y
Jil24
Asst. Professor ov4$o.J"., u,lono ltt.trJ cn)l.+-- l2'll 'os
S,ri V t{ Eq+aJ..'st t$ Al-,1
-q<al\7 o Q,og, o7 31. u,.09 3n21d
,4 +4

Jri !qkq-,Ld $4.ruq t/l.A,'*l 6l , 06,01 og, o!-' 1c 8m t+4


Assoc. c-sl
Professor 5ffis4Ji.,' NqY*,o ffi
M"Jl 26.1+'lo \2.t>,16 -/
L Ewr
qsll.f.
I q+,r Li
No
Professor
ofup*"1'u ^4df., 'lrr I

2^3'l;-'lb ,h il e"b, 5 Iro


c"ll ,tr N.Jl""< Y

* Wri te NA (Not Appllcable) for thc


dcsignations not t€ld
NMC- Faculty Declaration Form (2021-22)v.l.l
To be filled in by personnel from Indian Defense Services ONLY:

Designation Institution* From To Total


Graded Specialist
Classified Specialist
Advisor
* Note: Documents in support of esch posting to be furnished for verificatlon

14. Have you been considered in UG/PG, MCIAIMC inspection at any other medical college in
a teaching or administrative capacity during last 3 years. Ifyes, please give details:

Designation Subject College Dates

15. Details of employmentbefore joi ning the pres ent insti tion
a. Name of College/Institution c{t l,',1)

b. Designation: o&i ov Date on which relieved: CIt /o_t1/;g,oj_s


Y
c. Reason for being relieved: Tendered resignation / Retired / Transferred / Terminated
d. Relieving order issued by previous institution verified and attached: p-{es / No
16. PAN cardNumber: AJ LPb E3 )- o L
lT.AadharcardNumber: lloO 6 (l o25 6+
18. I have drawn total emolbhents from this college in the current financial year as under:

Month Amount Received TDS

1. April 2020
I I stoo 2oooo
2. May2020
/ zb9 a 2-o Oo o
3. June 2020
lQooou )-o oOO
4. I'tly2020 Rloooo o
Ltoon
5. August 2020
?loooo ?oooa
6. September 2020
2looou 9noa
7. October 2O20 &loooo Sooo
8. November 2020 RloPo SZooa
9. December 2020 SDN O
Qloto o
10. January 2021 2.lo oo a gDooD
I 1. February 2021 &\o ou o 4 sooo
12.Motch202l Xlo oo a foooo
FY 2019-20 (Assessment Year 2020-21)to
lcopy ofPAN card & Form l6(downloa ded from TRACES) for
be

attachedl

19. Number of Research articles in Indexed Joumals:


a. Intemational Joumals: - -9,1-
b. National Joumals: -95-
c. State / Institutional Joumals:
----
20. Details of other Publications:
a. Number of Books Published:
b. Number of ChaPters in books:
NMC- Faculty Declaration Form (2021-22)V.l.l
DECLARATION
l. I, Dr, L)' am worki in the capacity of sr
in the Department o f o LJ at Narayana M cal College and do
hereby give an undertaking that I efiployed as a full time teaching faculty, working
from 09-00A.M. to 05-00 P.M. daily at thls Institute.
2 have not made myself available to any other Medical College/lnstitution in any
I
discipline, in the capacity of a teaching faculty, administator or advisor in the current
academic year for the purpose of NMCMCI assessments.
3 I do hereby solemnly declare that (tick the applicable clause):
a. I state that I am not doing any Privare Practice or working in any other hospital
during college hours.
b. I praclice at Nursing Home / Clinic / Hospital
in the city of rn State and my hours of
private practice are from to AM/PM.
- -:- IAM/PM
4. I am not working in any other medicaUdental - -l- -
collegein or outside the State in any capacity:
Regular/ContractuaUAd-hoc or Full timeiPad time/Honorary.
5. I declare that I have provided all details with regard to my work and teaching experience
and no information has been concealed by me.
6. Ido solemnly declare that all the details/information furnished by me in this declaration
form is absolutely true and correct, and all the documents/certificates that weremade
available by me for verification or have been submitted by me along with this declaration
form are authentic. In the event of any information fumished or statement made in this
declaration subsequently tuming out to be false/incorrect or any documenUs or certificate/s
is/are found to be out of order, or it comes to light that there has been suppression of any
I
material information, understand and accepr that it shdl be considered as gross
misconduct thereby rendering me liable to disciplinary and/or legal proceedings. It might
also lead to suspensior/cancellation of my Regisration with the State Medical Council
and/or removal of my name from the Indian Medical Register.

Date:
ehce: [r] q] fot r-
(Signarure of Faculty)

ENDORSEMENT
1. This endorsement is t}le certification that the undersigned has satisfied herself/himself
about the correctness, authenticity and veracity ofthe content of this declaration form in its
entirety and endorsed the above declaration as true and conecl. I have personally verified
all the certificates/documents submitted by thc teaching faculty with the originat
certificates and documents that were submitted by her/him to the Institute and
confirmed the same with the concerled lNtitute and hare found them to be correct
and authentic.

2. I also confirm that Dr. \) R. is not indulging in private practice


of any kind or carryingr ut any other professional or other commercial activity during
college worki ng hours, from 09-00 AM to 05-00pM, s lnce she/he has joined
the Institute.
3 In the event of this declaration tuming out to be false or inconect or any part of this
declaration subsequently tuming out to be false or incorrect or
it comes to tight that th;
of any material information, it is undersrood *a u.""Ipt"J tt ui G
l1',^o.:::_::,t.":sion
unoerslgned shalr arso be equally responsible besides the declarant herself/himself, for the
misdeclaration or misstatement.

Date:
uace: $llovc_
Signature ead of Depr.) Signature ( ad of Institute)
with ollicial seal
Dr"BUURrs,prrro). ffi'ffiffiiffi|,9,0.*EGE
Regrt No.68691
Prolessor & FIOD ctit liEt,t:
D€oartmert ot Orthopaedics
,TARAYAIA
o
"
f A {"-i; ;;
I'E'ICA. ctI.EGE & HOSPTI
lhinthsreddyDatem, Ndlore-2. (
NMC- Faculty Declaration Form (2021-22)v.l.l

CHECKLIST
SI Documents Submitted
I Recent Passport size photo ofEmployee, Signed by Dean/Principal ofcollege up<?No
2. Photo ID proof (Govt. Authority issued): Passport/PAtrard/Voter lD/Aadhar Card ye</tNo
3 Certified copy ofAppointrnent order ofthe present Institute. uy'tNo
4. ProofofResidence: Passport/Voter CardlElecEicity/Landlinc phone bilU Aa{hd Card Y5lNo
5 Joining rcport at the pressnt institute Yc(/ No
6 Copies ofMBBS, PG, FhP degrees (as applicable). Y,{" t xo
't Copies ofMBBS, PG, Plrqdegree Registration Certificates (as applicable). No
",ei
y/vNo
8 Copy ofexperience certificates ofall teaching appointments beforejoining present post.

9 Relieving order from the previous institution/posting. v6tNo


10. Copy ofPAN Card ,/itNo
ll. Form t6A (downloaded from TRACES) for FY 2019-20 (Assessment Year 2020-21) v&tNo
t2 Letter head (in case ofteachers who arc practicing) Yes / No

I J. Copy of letter from affiliating University recoBnizing as UG tcacher Yes / No

t4 Copy oflefter from afliliating University recognizing as PG tescher (for PG sssessment) Yes / No

t5 Copy ofAadhar Card r{estNo

Signature of aculty oD.


Date:

il AP.
. (rNDtA)

Signature of H ead of Institute Signed & Verified (Assessor)

,t not be considered as a
^"r]-t-,,,
Teaching Faculty in case any of the documents listed above are not enclosed/attached with the
Declaration Form.

il) The Faculty member will not be considered as a Teaching Faculty if the original Appointment letter,
Relieving order, Experience certificates, Govemment Photo ID,Degre€s, Registration certificates,
pAN Card, Aadhar Card, State Medical Council ID (if issued) are not produced for verification at the
time of assessment.

rx) Faculty members must submit the revised Declaration form in this format only, Submissions in the
old format will be rejected and Faculty members will not be considered as Teaching Faculty.
.qIErE{ f,ATffiI qr{a. Ir{FFR
NICOIIITA)( DIPART|}{IIiT GOVT. OF II{DIA

R BIJU
.'t , !:_!

V DE{\
NARAYANA MEOICAL COUEGE
CHINIHAREDDY PALEM.
NELLORE. 524003.
ANDHRA PFIADESH. INDIA
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ffi AADHAAR

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XrSr'i5, *o$J / En.olment No. :2O17t6O14etO4g46

{t To
Biiu Ravindran INFORMATION
24-2-2A4
E Aadhaar is prool of identity, not of cilizenship.
sanlhiNaoar
Near srndiura nursino home
Ne lore
I To establish identity, authenticate online.
Nellore
Dargemrfla.Neltore
Andh.e Pradesh - 524003
9703816699

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eD C3 aJ"t $osrs / your Aadhaar No. :
I Aadhaar will be helpf ul in availlng Government
7100 617A 2564 and Non-Governmenl services in future.

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I ANOHRA PRADESH MEDICAL COUNCIL
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Certllicate of Renewal ol Reglstration
(Section - I 5C ol A.P. Modlcal Proclltloners Rcgislration (Amendmonl) Act. 2013)
(Soo Rulo . 6(13) ot tho Rulao)

SNo 205{7

Name of lho Doctor BIJU R

Falhar's Namo R,RAVEENORAN . -


Ragistralion Numbcr 68631

Date of rcglstratlon 26 Jul 2010

DatB of 8l(h 27 Mlr 1973

Oate of Renewal of Registration 22Oct 2021

Valid uplo 2l Oct 2026

Present Address 24121204, SHANTHI NAGAR EXTENSION


OARGAMTTTA
'
NELLORE Andhra Pradesh 524003

8_eglslerellq!-aljllca!Lo_a.lF)

Qualilication Date of Regislratlon

&t.B.B.S 26Jul 2010


u.s(oRTHo) 26 Jul 2010

Tnis,s lu ceflify (hal the abovc mcnlion(:rJ doctor having contplied wilh the requlremenls of
Stction-15C o{ A,ntll:i.a PradgEh t\,ledical Pr:rchtioners Regrslration A6l, 1968 1asamended Act lio
18120131and lhR rules marJe lirereunL.jer, hisrher rcgrstrat;on. has been renewed {or the period
tr.\o!tL,zz P9!J9?_1 to. 2 1 Oct. 2 0 26

Erc,rtta-
Yijayawada REGISTRA R
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NARAYANA MEi'ICA!. COI.LEGE
CHINIHAREDDYTJALELI,
NELLOnE . 524003.
ANDHRA PBAOESH, INOIA,
I

Phone Office: 04144 - 238010


msrnrnlch(('l,Yohoo'com

J
ANNAMALA! UNTVERSITY
RAJAH MUTHIAH MEDICAL COLLEGE HOSPITAL
5
Annamalaina - 608 002.

Date.
.1.>407

crilrrrrclrn

This is to Certi! that DT.BIJU.R, MBBS' M.S(ORTEO), hq


studied / worked as a Post- Graduate from 2000 - 2003, for a period of3

years, in the department of Orthopaedics in Rajah Muthiah Medical


i

College Hospital, Annamalai University, Annamalainagar, Chidambaram'

During the above course he has been involved in Undergraduate teaching.

i
I

Prof.M. B AN
I
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andHOD.,
ANN ATTALAI
.6l,urtivinstrv of Orthopaedics. l

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Ol llNl'l ln IIELIDYPn l.lrfv'I, l ll I rlll: ,,'4 tit)t /\ l-'

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l)illo ,'11 (rl ,',1 lll

PTTOCEEDINGS OT' TI"!E PRINCII]AI,: NAIiAYANA NlI-DI(]AL


: T:OL I,I;('I
NIILT]lJI

Prosetrt Dr. l-l.A llrrrrrnkrl6lura. M. [).,

Prlrrclgrrrl

9tlQElt,

'l'he Assoc. Ilrofusrst.rr irt llt,:


Prlnclpal ls pleasecl to appoint Dr. 11. L.llju, IVl.s., a,;

rtepatlntent rrf orthopaodlca, Nnrnyatrn lvleclit:rl t rlletle t/, Ilrr:rpit;tl, I'Jrllltrtc'

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Dr. R. Bl|tr, M.S.,

Nolk)re

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re Profi]ssor & l-lOD, Dept ot odhopaadlca' NM(;l l llellore

Nsllore'
I'he Meclical SuporintorrdBnt, I'IMCH'

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ltc l"inattr:e $ectbn, I'lMC' Nollore

-tul^ll$^U$U,'.ltu.]5:'
- NELtoRE'5e4oo3'-..
ANUHHA FHAOESH' INUIA,
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ANDiRA PRADESH,
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]IARAYAilA MEIIICAl Ctl I,[TG I
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(.)RE
CH lN l'HARI I)t)Y PAl. EM. hlELl 'i:'d {)oll A l', INDIA
O':0861 7ll1 /963. b4,6tl: l'rtt {)861.771 t96)
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Rnf.| 4ClAl_21 9{ 12018

G3 E R L: A MEplqAL csLl=.Lqtr
C
NE LLORE

Proaollt Dr. G. Veera Nagi tletltlY M'D '


Prlrrc l;ra L

ORDER:

WhllornodifylnglhoorrlerslsrruocllnthePror:eerlitttlsl'loNM(:/A/i1028/20'ltr'
t']rthopaorllt;s
01.08.20'1ll of the Irrlncipal' Dr' R BlJtr' M'S ' ['rotessot r'tl
datetl
Profesaor ln lhe depa'ttttetrt of
OrtlropRedlcs'
is re rleelgnated as Aegoclate
p6r leltor No h4( | lii(1)/2015 IE()/131880
Nara. Medical Collsgo' Nelltrro as 0l''00 2016
& MCI Lr'No'MCl-259(2 2lt2t)|O'Mel /1''rl9BB clalr:rl
rlated 03 0g.2015
wilh lllrnledlat6 offecl '

lhn Prolessor & HOD of ofllropaerlk-'s


fle ls requestotl to repott to

11.r,,,'.
r/ ,/r,
AL
lfi,llil,!,{f
HAIIAYAIIA t tln(l/1l (;(ll lliil
l.lr I l( )lllr 524tXIl. A.t'

lo

RLX; ?"l t[;l;sot or c)tthopaetri':s


tiollego'
NaraYatta Medk;al
l'lellore

NMCI'l' l'lellt'te
\1,']lLli,*".", & l.1OD, Dept t)f r')rth()paodlos'
I l[ il:'J,iffit;.."I"' ia""t NM( :H' Nerror 6

1$
'vbr.,-
-DEAN
TIARAYANA MEDICAL COLLEGE
CHINTHAHEODYPALEM,
NELLORE .524003.
ANDHRA PRAOESH, INDIA.
t'it"
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t{Affifryffi ruffi ffiTffi mt$fl r" 0 0tr,tff
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\(!' o : 0Bol-)31 /96:t,64, bt\ Fox : 0lldr 1 ?31 /96,)
E nrcril : r'roroyrrrrrrnro,Ir;rrlgdycrl.roo cr,nr

Office oI lhe Prlncipal


Ref.No.NhrlCiA/ .l tt r-l2\ lt) L)ale 2:l 12 2016

PROCEEDINGS OF T E PRINCIPAL : : I!4EAYANAMEAICAL qoLLEliE,


NELLORE

Progorrt: Dr. G. Voora Nagl Redrly, M.D.,


Prlnc lpBl.

Sr.rl;; Narayana Medi,ral Collego, Nellore '- I Btablishrlr6nl


Dr, R, Biju, Associale Professor o[ ( )rllr! )l)aeclics --['r (,nrolion
as Professor -- ( )rdere lserrad -- Rog

Ref: '1. - 12(2\2Oog-MED - 22854, dateLJ 2 lsr July,20()t)


MCI
2. MCI- 12(1;2015 - TFO/131880 rlalerl 3'd Sepl6n)ber, 20'15

QRDERI

1-he Principal io pleased lo pronrole Dr. R, Biju, M.S., preserrlly worl,.incr as


Associats Professor of t)rlhopaedics, N0rayarla Medlcal Llollel;e, Nellore as
Professor ln the deparlrnertt ol Orthopaedlca, Na,nyatta Merlical oolloge, l,.lellore
w.a,f ., 23,12.2016 as pet Medlcal Coutrcll of lntlra togulalirrrr l90B atttolcltttent
vicle No.MCl 12l2ll2}og - MED -- 22654, clatorl 21"' July, 2009 and 15.12 2001)
-
'fEQ/13{880, dated 3"i Soplalnbor, 2015
anrl No.MCl-12(1YZA15 -
,l { 11
' ., l, i,'
PRINCIPAL
'I ri'! rirr
t,. i, itli'. 1 ' lll li, I

'l-o 1.'1i,,,:rr'"illi

Dr. R. Bl.lu, M.S.,


Assoclate Prof6sEor of [)rthoDaeclics,
Narayatta Medlcal College,
Nellore

Copy lo
'[he Dlrector, NMI
The Merlical Sttperintendent, NMCI-1, Nellote
'[he Coordlrtator, NMC, Nellore
l-ho Professor & llOD, L'ept. of Orthopaedl<;s, l"tvl|l'1, Nellore
'fho [:lrranco Section, NMC;, N8llore
Ih6 HRD, NMCI{, Nellote
The MRD, NMCll, Nellore

NARAYA.NA MEDICAL CL'I.I-


CHIIITHAREDOYFALTI.'I,
NELLORE. 524003.
AN9HBA PRADESH. INDIA.
JQlx.NaBEfo_BI

D"r", .2
1
l.:!. l(.

To,
/
The Prinoipal Medloal Superinlenrlent,
Narayana Medioal College & Hospltal,
C hinthareddypalenr,
Nellore.

Sit,

Sub: Joining Report - liubmltted - Reg.


Ref:

-t
As per the reforehce cled above, t Dr .I l L2 dl/ly lf: il?
1A 1'r
t_
.loirring as 0,n ,1, {st : t.. in the cleparhnetrt of . . . 9r..{.'lll"q ''{ i' ,.
d'I
.m lh6 forenoon / afternoon

Thanking you,

f
.i
Yours fa lthfully,
t.':,\l'

(Dr Il t-J:) A, )

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MCI Regional Centre for Medical Education Technology
TflDU8*. MEDTCAL GOIJ.ECB, 1ISAIQI.[PATN*}I, fiNDf,8.*. PB.fi.DBSU, INDI,*.
Sensitisation Program on ATCOM
i***

Certificate of Participation

'Ifiis is ta certify tfrat tDr.


8/711. R
Aepartmtnt oRTHO?+C2/CS fron /1frl"?bt//' fre47
a/Le66 , 4/6/UR€ fias partbipate[ in tfie Sensitisation Qrogrdmme for
nttitude an[ Communication (AGCo*l) glotub organizet fu tfu tulCI Rg{iarut Centre, Adrtra %.ef,kd[
Co1tege,'?bak $apattum, fi.ndrtra Qratesfr on A.zilo 2a eaft

pal Convenor, MCI Regional

L
::fl#*flF"ryff,1ff..
1

MCI Regional Centre for Medical Education Technology


flIII'gB.E. HEI'ICAL GOI.I TqS, VISAKflAPJITNA}I, ANDflR^II P8.*,DEStr, IIVDIA
Revised Basic Course Workshop in Medical Education Technologies
J.***
Certificate of Participation

'Ifris i to certifi tfiat tDr. Bt{u. R rProfessor,

rDepartment o Oetnopeorcs .f,,, NeR47,il/4 l4Eilced


Abane , lVe/LoRe fias pdrtictpate[ in tfre fuvbe[ @asic Course 'Wor|gfrop in

gvle[ia[ E tucation technofogies fiet[ l?-E-eaE tu3I-12-2ol7b tfre %cI fugioad[cmtre,


Antfira n4efrca[ goficge,'lisafi,fitpatnam, Anlfrra tPra[esfi.

Convenor, MCI Regional

M
roNwwAreffi g$LtE-GE
w ffi Effi UUroL
. :!EEl
f

Chinthareddypalem, Nellore - 524OO3


DENARIII,ENT OF TAED'CAL EDUCATION

&dRevised Basic Course Worksho p & AEICONT


(Approved by MCI)

,= @ertfficute of lBsrtictpotton
6_?B
$F=E
{6is is to cerfifu ffraf0r. BI:Iu RAvJNDRAN
gf**Er
;:SE5
Oepattmenf of DRTI-}O PAI: DI-C-S fro ra N* RAyANA ME-)i cAL
QEtr
c,
m LoUeA€, NE LLa"E 6ot parficipafedin thc al4 Rpasef,tsasic Couse'lhorbilof &, AEflC7M

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IOSR Joumal of Dental end Medical Scicnces (IOSR-JDMS)
e-ISSN: 2279-0853. p-ISSN: 2:79 0,\hl.y,)lwne 18, Issue 12 Ser.8 (December. 2019), PP 64-69
t ) w tt,. i os rj our na ls. o r g

A Study of Functional Outcome of Distal Tibia Fracture Treated


With LCP L,sing MIPPO Technique
Dr. Biju Ravindran. Dr. M. Kotoshwar Rao, Dr. Chandana
l)eptrtnent ol o rrlul'. ,l tt , Nunr.yotn Nlelial (-allege &Hospitul. lndia
L)epdttknt ol atthot,,,ltL. Nura.wrm Nledinl College & Hospitul. ltdia
ann|'t)trl'ii g aullt.)t l)t. Biitr Ravnclratt

Abstrqct-Fracture\ of the distal til)ta L]re olle of lhe losl challenging for tredtmentbecause of limited soli
tissre,subcutaneoutlocation of bone,and radtu ed vasculaIity.Thete j'actures are ircrcased frequently wtth road
trajJi( accidents. Nowado.r's, these /iarfitrcs are h'edtel with LCP usittg minimalu invasive petcuta eous
p lot ing osteorynthe s i s(MI P PO).
Objective- To evdlwte the.litnctional dhl ruliological results oJ LCP using mitlimalbl invasive percutaneous
p latiry osteosynlheti s ( MI PPO).
Methodology-Tht prc.sent stud;,u,os cou,ltrcted h lhe.lepartfie l oforlhopedics, Narulatra Generul Hospital,
uttoched lo Norayuna )l4edit al Atltuge \clh re. Inoursudr,, l5 potients of both nales antl fetnales inclucled
with dislal tibia lmcttu'e operated br : ( Pltsing lhe MIPPO technique.anl tlrcy were assessed clinitally,
fiutclio a y, dnd ntdiologLcdlevaluatiotl [he\'$,ete_frllo$ed up dt u tegular interyal of 6wceks,3,6t1@ntht', a,kl
I _rear. Bdsel on AO F.4S.the t linit:ul rntt', t,n, ( \,aluated

Results-ln off st,./Jr, Thc tnean age *r .l-, -61+7.5 5 ( > l Syeors of age))u'ith male predomina ce(60o/o),average
time betweefi ihjtr-u d d s rgety is -l-4itt\!.uwrcge duruion of surgery wd,s I hour to I antl hary-hour fiedn
itltet,ral period was 8.2 n@nths,avcragt period oJ co,lsolidatio v,as 24 to 26 wceks, all patients achieveal
functional range ol ankle ttovenunts dunng lollo ,up peiocl oJ 6ntonths to lreir 7hefunctional outcohp was
measured usittg tlta.lOF.4S .5col? r1'4r \'! tt lrc end 01 26\eeeks. Co plicatioks like I case of lhe plate
etpose(l,2c\tses ol \upcrli.lut in/bction' ttikl I (o.\( of'\4und dehiscence and no other complications like
contporment s_vndr,tntc.tron-ttnion, i tpfu,tt /i1tI re.
Cottclrtsiott - LCP using the MIPPO r,.h ique is a biologicall.v, fi-iendly, and technicallv souud metlnd oJ
.li.ralion. ll/hile dpplied subculaneousb', tt htr.\ t1dt1i, udrdnktges like tess s9[[ lissue ddmage, does not efidanger
periosled blood supply, ond does not dtsrto b the Ji.actu'c hematonta,and it results in fewer complicatiotls. LCP
using MIPPO nor'a .ttitablc dl nrelal)11),st,tl .onninution Ji'actlu'e

Datc of Submission: 09-l 2-2019 Date of Acceptance: 24-l 2-201 9

t. Introduction
Fractures ofthe d,stal tibia .uc ,'rc ol thc rnost challengirlg for treatmentbecause of limited soft tissue.
subculaneous localron ol bone. and poor \ irscularity.Thc laslcst growth of technology and urbanization has Ied
to a nlassive increase invchrcles on thc road.and mostly nlolor vehicle accidents cause long bone liactures,
particularly tibia drrc to subcutaneous lorntion. Mainly these fiactures can be managed by various methods Iike
nonoperative treatment.extemal fixatioo. rntrlmedrrllary nailing open reduction wilh srnall wire fixatiolr. and
plales-However, each of these options hrs associated wilh certain complications.In recent times, practices of
closcd reduction and minirnally invasivc plate ostcosynthesis (MIPO) with locking compression plate (LCP) has
emerged as a substrtut€ trealmena option lor distal tibia liacture. Wlren applied subc[taneously, respecl lractrlre
hematonra, LCP does not cndangcr fr(riosteal blood supply, and also plovides a biomechanically stablc
constRrct (7). The numbers ol earlier clir lll 't! ies havc est.rblished MIPO with LCP as a biologically f'rienclly
and tcchnioaliy sound nlethod of fixation tar Jislal tibia t'raclure. Hcre wc assess the resulis of the trealment of
Dislal Tibial Fracture by l\'linimally Invr\rvc I)ercutarcoLls Plate Osteosynthesis using Locking Cornpr'ession
Plate -a prospective study. Thc .bjective olthis study wits to cvaluate the furnctional and radiological
rcsults of LCP usirg rninimally invasi!r pcrcutaneous platiug osteosynthesis (MIPPO) techDique in distal tibia
fiaclure.

DOI: 0.9790/035i-i 8120s6469


1 wwrv.iosrjournals.org 64 | Pagc
A Stltdy ol Fur. tiondl OLt(:on1
"_,
tr D:', 4Jlbil!lyt,::!::!:! !y!!St U.s in s M ippo rechnique

ll. Materials& Methods


This prospective obscrvational study wilr cirn ied out on patients of the DeparlmeDt of orthopedics at Narayana
Medical College & Hospital. Chinthrre(l(l\'talem, Nellore, Andhra Pradesh from September 2017 to July 2019.
A tolal of I5 subjecls ol-bolh sexes. ofag. more than 20 years wcrc included in lhis study,
Study Design: Prospective observational iludv.
Study Location: This rvas te(iary care lcxching hospital-based study done in thc Dcpartment ofOnhopedics at
Narayana Medical College & Hospitll. ( lrn(hareddypalcrn, Nellore, Ardhra Pradesh.
Study Duration: Septe,nber 2017 toJul\ l(ll9-
Samplc size: l5 parienls.
Sub.jects & seleclion rnelhod: The strdy 0, 'pulation rvas dune on all adults (> I 8 years age)who werc admitled to
Narayana Medical CollcBe & Hospihl \ rrh drstal tibia liacnrres d[ring the period liom September 2017 to July
2019. All the adults who uill be r4rerltcd during this peiod are included ir thc study. The paticnts were
evaluated clinioall) and radiologioally. ,\llthc patients wele followetl up for an average of6 months to I year.
The outcome was assessed usingthe AOI \S Soore

lnclusion crileria
l) Adult patient Drore than 20 years oIl*c
2) Closed fractures and compound -Gusrrlo & Anderson classiflcation type lband tlpe 2
3) Extra-articular nrctaphyseal sinrplc. rnclaphyseal wcdge, and nrctaphyseal comrninu!ion

Exclusion criteria
l)pati€nts are not fit tbr surgery and irnaclrh.sia
2)Open fractures
3 )Pathological fractures
4)Partially articula' distat l/3'd tibial fiactrrrcs
5)lntraarticr ar fracRlre
6)Compound injury-Gustilo and Andcrson type 3
Procedure Methodology: All adults morc lhirn l8 years ofage with distal l/3"rtibia fractures oftibia admitted
al NMCH, Nellore - nrceting the inclusr,,n ilnd exclusion critcria were subjects lor the study. As soon as the
patient was brought ro casualty, the palr!|l s airway, breothing, aDd circulation were assessed aDd,a complete
survey carried out to rule out other irllLrrics Plain radiographs of anteroposterior & lateral views of- leg
including knee joints & ankle lbr tibrrr to assess the site of the ftucture, the extent of comminulior &
displacement weretaken. ()n admission. dctiriled history has taken & examination is done and posted for
surgery. Routine pleoperativc prccautions rro taken. lntraopcmtivc assessment: the length ofthe plate is chosen,
such that each plate shoultl bc 3tiraes largtr tirin fracture. Pre-operative assessmcnt ofthe length ofplate chosen
Diagnostic criteria: Distal tibia tra.rrrrcs: Fracture ofthe distal l/3rd ofthe tibia present 4cms-l tcms
above the intraarticulrr distal tibiLrl surl'ircc.
Evaluatiol of SyndesmosisThe simp lesl nr!,lhud is to measure the distance between the rnedial wall of the fibula
aDd the incisuru surlirce ol thc til)ia. l|is tibiofibLrlar clear space should be less than 6 mm on both
anteroposterior an(l Mo.tise views. Thr tibofrbular overlap ol less than lOmm is abnorma! and implies
syndesmotic injury.
Computed Tomography-The cornlutc(l romography (CT) scan helps to delileate bony alatomy,
especially in pati(nts with an intraarlrLulrr distal tibiainjury
Magnetic Resonanle Imaging-Themagr)(tic resoraDce imaging (MRl) may bc used for assessing occult
cartilxginolls, ligilrncnlous. or tenrlin,'rrs irrjuries.
P!'e-operative prepirration ofthe p{tic l lbr plating
-Preparation of-Paticnts wcrc kept nrl b|Doulh (NBM) for 6 to 8 hours befole stlrgcry. --An adequate amount
olcornpatible bloorl. if necded, was anangcr.l.
whole extremity/ pflvale parts and bnck \\ ils Llone.
-Written informed consent uas taken l.\ rtntrbiotics given one hour before the procedure.
Surgical techniqucs ol'MIPPO platin!r-Pilticnts lvere opetated under aseptic coltditions, under
spinal/cpidural ancsthcsia in a supinc losition; tourniquet applied at the proximal{high.
r The aftected limb is scrubbc.l thoroughly tlom mid-thigh to foot, with betadine, after that
painting with betadine frorn mid-lhigh lo loot, draping done. Tourniquet inflated, at'ter the elevalion of
lhc lffected limb
A small incision ot-size 5 cnr (curvilrn,iilr or vertical incision) given at anteronledial region nt the level
of the distal tibial articular surface an(l cxtend proxirnally along the medial surface taking care, not to
injury the saphenous vein and ner! e

D0l: I0.9790/0853- lli 12036-169 rvrvw,rosr'lolrrnals.org 65 laSe


A Studt' of Funclion(l Outcont? o/ I)i.\tol Tibio Fracture Treated llith Lcp Using Mippo Technique

Suboutaneous tissue incised and cl(]vatcd rvith long-handled periosteal elevato, and the plate introduced
a 4.5 mln systenr below the lunrcl 1\rlh the help of the locking sieeve, itnothe,- ond of the plate is
palpated 3 to 5 ctu size incision givcrr. Ilv using 2-5 to 3 mm K-wire fbr ternpora.y llxation ofplate
distally and proximally and reductior eltccked under (llTV) for reduction ol fraoture fragments and
length of p)ate alignrnent

\\
It is approprinte (ap anglllations l0r, shortening <15ffm and varus/ valgus <5o) was considered
acceptable criteria tbr reduction. l,!'tbre applying screw sagging ofdistal tiagrnent was prevented
by putting to\vel roll under iacturc srte, distal cancellous screw is fixed, and proximally near the
fracturc site of proxirnal fia!m.rl one oortioal screw in fixed compression oslcosynthesis was
achieved as hvbrid tl xrt io n.
K-wire rernoved rud allorred lhrc( locking sorews applied on cither side of liacture was given
with normal saline. Homeoslnsir .lchieved. Subcutaneous suturing done with absorbable suhlre
material. Skin sulured with non-alriorhable suture material.
Tourniquet dctlatcd,compression hrndage applied belorv-knee slap applied posteriorly.

POSTOPf,RATIVE CARE FOR PI-.\I'ING PATIENTS


o NBM for 4 to 6 hours poslopcralr\cl), LV. Antibiotics and I.M. Analgerics, tinrb cievation over
the pillow, active toc and anklc rr(r\'enlcnts
. Chcck x-ray of operatcd libia llll lcrrBlh inclucliug knee alrd ankk: joirrts in both AP ancl LAT view
l.V. Antibiotics for I" fire days ol rhc fostoperalive period, after that switch to oral antibiotics for
?days. Patients allowed no wcight-hriring crutch walking on I'r postoperative day,2,d and 51h PoD
dressings,ll'r'or 12'r' POD sutufu rcrnovnl, only if there is no gaping and surgioal wound is healed
Partial weight-bearing using rvalkcr ,rlier 3weeks /depending upon type of lracture and rigidily ol
flxation, after that every month up lr) 2months tbllow up, after 6months attcr surgery,patient was
individually assessed clinically and rt'rliologically

Statistical Method
Frequencies--The Frcquencies pr()cc(hrrc plovides statistics and graphical displays that arc trsefill tbr
describing many t; pes ofrariablcs.
Independent-Sample T-Test- Thc In(lcpcndent-Samples T-Tesl procedure used nleans lbr two groups of
cases. The subjects should be assigned t,J t\ro groups so that any variation in response is due to the treatment
nnd not to other differcnt factols.

Ill. Obscrvation & Results


lrr l)lc I A r Distribution
25,35 l 6.6',1
36 -15 33.3:l
,40 -55 I 51.33
I

Tot.l t5 100

DOlr I 0.9790/0851- 1 8 120Ii5469 wwrv. iosrjournals-org 66 Page


A Study oJ Functioldl Oulcot e t)/ Distol Tibia Fructure Trettted ll/itlt Lcp Using Mippo Technique
'l'nblc 2 NtcnI
{5.67
?.55

l'rbh 3 Sex Distribution

40.00
l0u

frble.l Plali I'rocedurc

100
100

I altlc 5llrrdc ol l

I 6.61
IITA tl 3{1.00
l3_.13
100

l'nble 6 rvei h t -1, e,tri n

r00

100

I rblc 7 Knrc llOU


KNtiu R()tI \TIIIRI.]R OF P I'IIiNl'S I'EIICIIN'TAGE%
IIULL 86.67
NORtt,\1. 1-1,-1-1

NEAR NORTI.TL 0
TOT I, 100

lxl)lc 8,\nl(l( I{Of{


I{()NI
^nkle
I:u ll

20.00
l0u

'l rl)lc 9 Tinlr for union


1.11
0.67

I xt,l( no l0 Conrlrlic:rtions

ll
I 6.712
l r3.tl
I 6.712
0
0
lanl liiltrr!/notr{nir'n 0 0
26.U7{

DOI: 10.9790/0851-l lt 1201i6469 www.iosrjournals.org 67 | Page


A Study oJ Functiondl Outu)ne ol Di.\tol Tibia Fructure Treated llith Lcp Usitrg Mippo'fechnique

PRE-OPER \-I'I VT] \-R\\ S IIVI illEDIA'I'I' POSI'-O PERATIvE XRAYS

I-YEAR FOLLOW UP XR \I S CI,INICAL ANKLE NIOVEI\IENTS

PREOP!]I],ATIYI, X RA\ S IMIIDDIATtr PoSI OI' XIi YS

FOI,LO\I trP OF 6 t\'lON l HS ,\l'l'Ell I-YEAR CLINICAL ANKLE RONI

l\'. Discussior
In our study.thc distal l,'3rd tibra liaolures are more common due to RTA,{ccounting for 12 cases,fall
fiom heighl I case, and tlr'isting of rrrjrrrr 2 cases. The ne0n age ol patients rangcs fiom 33 to >56and average
age ofpaticnts 33.llyears. Mostly 9mrl! p,rients(60yo)are involvctl, ancl 6fenale patients (40%)involvcd, the
average sex ratio is 60140. In our sludy.nrostly all paticnls have delayed weight-trearing and early mobilization
of ankle, and loes movc,rcnts, and rro inrnrediate weight-bearing is seen. Range of rnovemerrts in the ankle,full
mnge seen in 7 cases (4(r.67 t,near ((' nornral in 5cnses (31.33),and midrange of movements in3cases (20). In our
study, union altained in.lto 5mon!lis(4.-.1_ nlonths average) due to the presewation of fracture henlatoma without
Llisturbing. Distal libia linclrLres ass,rcirttd Ilong with soll tissue injury and coumiflution of rnetaphyseal and
a(icular liacture tiagnrcn{s oftibicl plxldnd d e to high energy trauma. This type of fiactures is challenging
bccause of its subcutancous Iocalion.poor \asrularity. and limited sofl tissues. LCP using MIPPO techniquehas
rdvantages iu lreatirg disral tibir liacture like minimrl iucision,less ialrogenic solt tissue damage prcservirg

DOI: 10.9790/0853-l 3 12036469 www.iosiournals.org 6lt Page


&
{? TDS
C.rtdnd Fnxani.qcan
TRACES
TDs R€cqnciliation Analysk and correctioo Enabling system
1+l+r

FORMNO. 16

ts€c rule 3l(lXa)l

PART A
Cerlificrte under Sectlon 203 ofth€ Income-tu Act, 196l for t.r deducted rt source otr srhry

Certificrte No. ACWSUIA Lrst updsled on I l-S€p2021

Nlm€ atrd rddress ofthe Employer Nam€ rtrd ddre$ oflhe Employee

NARAYANA EDUCATIONAL SOCIETY


I4'2, HARNATHPURAM, BIJU
NELLORE . 524003
63.8, SANKARAN AVENLIq VELACHERY ROAD, CHENNAI -
AndhE PBd.sh
600042 Tamil Nadu
+(9tl86t-23m624 I

VENKATAANILKUMARK@NARAYANAGROUP.COM

Employee R€I€reoce No.


PAN of the Employee
PAN ot the Deductor TAN ofthe Deductor provlded by rhe Employer
(tf rvrihble)

AAATNI6T2R HYDN03OO8F AJLPBS32OL

CIT (TDS) Perlod with the Employer

From To
Thc Commissioncr oflocomc Tax (TDS)
Room No. 4l l, Income Tax ToweB, lG.2-3 A.C. Guard , 2021-22 0l -Aftr-2020 3l-Dec-2020
Hyderabad - 500004

dedu.l.d at sourc! thereon h respect ofthe employee

Receipa Numbers of origln.l


Amoutrt of trr deposited / r€mitted
qu.rlerlystrtement ofTDS Amount of tar d€ducled
QurrterG) Amount paid/credi(ed (RsJ
under sutssectlotr (3) of (Rs.)
Section 200

Ql QUFMUCTA 431600.00 60000.00 60000.00

Q2 QUHCZDNC 630000.00 r20000.00 120000.00

Q3 QULQGAHG 630000.00 150000.00 150000.01)

Q4 QULPIATIA 630000.00 185000.00 185000.00

Totrl (Rs.) 2321600,00 5r5000.00 5t5000-00

I. DETAILS OF TAX DEDUCTED AND Df,POSITED IN TI|E CENTRAL GOVERNMENT ACCOT'NT THROUGH BOOX ADJUSTMENT
(The deductor to provide paymer( wise details oflax deducled snd deposited with respect to the deductee)

Book Identificrtion Numbcr (BlN)


Tex Deposited io r$pect of the
Sl. No. deductee Drte of tranrfer voucher Strtus of malching
Receipt Numbers of Form DDO serlal trumber in Form tro.
(R5.) (dd/mm/y,,)T) wilh Form no.24C
No,24G 74G

Totrl (Rs.)
II. DETAIIS OF TAX DEDUCTED AND DEPOSITED IN THE CENTRAL COYERNMENT ACCOT'NT THROUGH CHALLAN
(The deductor to provide payment wise deiails oftax deducted and d€posited with respect to the deducte€)

Chrllan ldentifi c.tion Numb€r (ClN)


Tcx Deposited ill respect ofth€
Sl. No. dedllclee
(Rs') BSR Code ofthe Bar* Drte on which TsI dcposit€d Chatlatr Scrial Number St.tus of mstching wilh
Brrrch (dd,imm/)yn) OLTAST

I 0.00 04-08-2020 r
2 20000.00 6190340 01-08-2020 07253 F

3 0.00 0+i l-2020 F

4 0.00 oa-l l-2020 F

Pagc I of2
C.rri6$t. N!oh.r: CWSUTA T,t\ oaE p'lo!.a HYDN0T{0ar r^lt .l EDployd AJLPE 3T0L

Tu Depositcd itr rBpect of the


Challrn ldentificrtiotr Numb€r (CIN)
Sl. No. deducte€
A!.) I ssR code ofrhe Br[k Drte otr rvhlcb Trx deposited Challan S€rial Number Stltus ofmrtching wi(h
I rnncrr (dd/mr/yyly) OLTAS'
5 2oooo.ool 63903,{0 04-t t-2020 02291 F I

6 2OOOo.ool 6390.]40 04,1l-2020 02291 I F


7 40000.001 6390340 M-l t-2020 02290 F

8 30000.00 6390340 M-l l-2020 02290 F

9 50000.00 6t90140 t7-11-2020 02473 I


I
F

t0 50000.00 6390340 r)7-t2-2020 9',7324 F

ll 50000.001 6390340 01-01-2021 78324 F

t2 50000.00 63901,10 I l-01,2021 05280 I


F

13 50000.00 6190340 06-02-202t t9589 F

14 45000.00 6390140 060t-2021 43961 F

l5 90000.00 6390140 26-M-202t 09930 F

Total (Rs.) 5t5000.00

Verifi.ltion

PUR'
or Rr. rl.lioolulo lRi. rrv. I rth Frrtc.n rhotrrrnd onrrl
lo lhe credil of the Cenlril Gov€r.ment. I turth.r a.rtlfy t[.] th. lnfo]E.aloE glr.n .bov. h.tru., iomplet. .rd .orrect .nd ii bried on rle

Placc NELLORE

Dste l5-Sep202l (Sign.ture ofperson responslble for deduction ofT0x)

Designrtion: SECRETARY F l Name:KOTESWARA RAO RAPURY

Not€i:
I. P.d B (Anno(Urc) of tE ccflinerc in Fom No. 16 lball be isslcd by lhE employc..
2. lfo 6ss.e is omployed ud.r oc .nploys duing lh. y@, Pan'A'ofthc c.niicalc in Forn No.l6 irsud for lhc qusn6.nding or 3lst Mmh oftl. fi@ciat yeu shatlcontain th. detsils
ofr&\ deducr.d and deposil€d for all th. q.sne6 oftle financial yw.
dscsee eas mployen *i& each of $e.mploye6. Pan B (Anmxu!) of fte..nifc.tc in Form No. 16 mybe irsued by clch of fe cmployers o. t[€ lat oploycr ar tbe oltio! of the lssesg.
4. To updare PAN d.tlilf h locod. Tar( Departrnml &Iabe, spply for 'PAN charg. rcqudf rtrcugh NSDL or UTITSL.

Leg€nd us€d in Forlh 16

* Strtur of Drtchltrg wlth oLTAs

Dqluclo6 h.v. not deporited la\e! or hav. Rlmished irconed pdiculdrs of iax paylnent. Final .rcdit eiU be eflected only when parnclt
U
detailsi! b!* mrch wilh dcuils ofdcposit in TDs / TCs slarcmmr
Prcvisio@l iq crcdn is cflecled only for TDS / TCS SlltemmG filcd by Covcmment d€duc!oB.'P' stalus will bc chantcd !o Fin.l (F) on
verification of p.yment deraih submiLtedby Pay od Aeounts Omcer (PAO)
Ir clse of noFSovc,rtl:mr d.ductors, paymcnt dclails of mS / TCS dcposited in bank by deductor iavc matchcd with &e palmnt detlils
F Fiml menrion dinrh.mS/TCS$atcme fil€d by tlE dcducios.ln ce ofgovmEc d.ductors, dciails ofTDS /ICS booked in Covernmcol
lelMr have b..i verifi€d by Pay & AMuDls oflis (PAO)
P.ym€at dcrails ofIDS / TCS dcpodir.d in brlk by deduclor havc D.t hcd with dcr.ils mmtioncd h lhc TDS / TCS slotemmt bul thc
o arnourr is ovc. claircd h $e sta!.sr.rr. FiEI (F) cr.{it will b. relkclcd only *tcD duc.or Edu6 clrim.d arnounl it the $alemenl or
,Ekes ncw psymenl for excess mount claimed in lhe slltemenr

las. 2 of2
NARAYANA EDUCATIONAL SOCIETY
PAN ofthe Deductor: AAATN1672R TAN ofthe Deductor: HYDNO3008F
PAN ofthe Financial Assessement
Name ofthe Employee
EmDloyee Year Year
DR BIJU.R AlLPB8320L 2020-27 2027-22
FORM 16-PART B (Annexure)
Details of Salary paid and any other income and tax deducted
1. Gross Salary
(a) Salary as per provisions contained in sec 17(1) 23,?7,600
(b) Value ofperquisites u/s 17(2) (as per Form No.12BA, wherever
applicable)
(c) Profits in lieu of salary under sedion 17(3)(as per Form No,12BA"
wherever applicable)
(d) Total Salary 23,21,600
2, Less: Allowances to the extent exempt under sedion 10
3. Total amount ofsalary received from current employer [1(e)-2(d)] 23,2L,600
4. Deductions under section 16
(a) Standard deduction undersection 16(ia) 50,000
(b) Entertainment allowances ulder sedioll 16(ii]
(c) Tax on employment under sedion 15(iii) 0
5. Total amount ofdeductions under section 16 [4(a)+4(b)+4(c)] 5 400
6. Income chargeable under tie head 'salaries' (3-5) 22,69,200
7. Addr Any other income reported by employee under sec 192 (2b)
[a) lncome (or admissible loss) from house property
reported by employee offered forTDS - u/s 24(b)
(b) Income underthe head other sources offered for TDS
8. Total amount ofother income reported by the employee [7(a)+7[b)]
9, Gross total income (6+8) 22,69,200
Gross Dedudible
Amount
10. Deductions under chapter VIA
(al Deduction in respect oflife insurance premia, contributions to
provident fund etc. under section 80C
[b) Deduction in respect ofcontribution to certain pension funds under
section 8oCCC
(c) Deduction in respect ofcontribution by taxpayer to peNion scheme
under section 80CCD (1)
(d) Total deduction under sedion 80C,80CCC and 80CCD(1)
(e) Deductions in respect ofamou[t paid/deposited to notified pension
scheme under section 80CCD [18)
(0 Dedudion in respect ofhealtl insurance premia under section 80D
(Self/famtly & Parents)
GJ Deduction in respect ofinterest on loan taken for higher education
under section 80E
(h) Total Deduction in respect ofdonations to certain funds, charitable
institutions, etc under section 80G
(i) Deduction in respect ofinterest on deposits in savings account under
0) Amount dedudible under any other provision(sJ ofChapterVl-A
11. Aggregate ofdeductible amount under Chapter Vl-A
12. Total lncome (9-11) 22,69,200
13. Tax on Total lncome 4,93,260
14. Health & Cess @ 4% (on tax at S. No. 13) t9,730
15. Tax liability (13+14) 5,r2,990
16. Less : TDS 5,15,000
17. Tax payable/(Retundx15-16) t2,010)
VERIFICATION
l, XOTESWARA RAo MPIIB)L son/daughter of BAPIJBI AUDISESHAIAH working in the capacity of AIIItrQBIZED
S.IGNAIOBI[designation) do hereby certiry thatttle information given above is true.
Place: Hyderabad
Datet 37 /07 12027 [Signature ofpeNon responsible for deduction oftax)
Desisnatlon: AUTHORIZED SIGNATORY Full Name: KOTESWARA RAO RAPURY

r5I

$*
-:
:+&m,',i,i,Y:'
NARAYANA EDUCATIONAL SOCIETY

Pay SIip for the Month ot Apil - 2022


( Amouhts in INR )

Name DR 81JU. RAVEENDRAN Emp No 408-00318

Department ORTHOPAEDICS
ESI NO 0

Des ignation PROFESSOR AND HOD

210,000.00 PAN NO AJIPB8 32 OL


Gross Salary

Total Number of Days : 30 Paid Numbe! of Days: 30

Earnings Deductions

Basic Salary 73,500.00 PF Contribut.ion 0.00


House Rent ALlowance 29, 400 .00 Professi-onal Tax 200.00
T!ansport Allonance 5,300.00 Income Tax 60, oo0 . oo
c.00
LTA 31,500.00 ESI
Medical AIlol,rance 10,500.00 Salary Advance 0.00

Food AIlowance 16,800.00 Phone 0.00

Personal AI Iowance 10.500.00 GMC 0 .00

Education AIIowance 4,200 .00 Food Coupons 0 .00

Monthl,y performance 21 ,300 .0o Misc.Amount 0.00

210,000.00 60.200.00
Net Pay Rs. One Lakh Forty-Nine Thousand Eight Hundred only 149,800.00

Generated on .: 0910612022
NARAYANA EDUCATIONAL SOCIETY

Pay SIip for the Month of i|day - 2022


( Amounts in INR )

N ame DR BIJU. RAVEENDRAN Ernp No 408-00318

Department ORTHOPAEDICS
ESI NO 0

Designation PROFESSOR AND HOD


PAN NO AJLPBS 32 O1
Gross Salary 210,000.00

Total Number of Days : 31 Paid Numbex of Days: 31

Earnings Deductions

Basic Sala ry ?3.500.00 PF Contribution 0.00


House Rent Allowance 29, 400 .00 Professional Tax 200.00
Transport Allowance 6, 300.00 Income Tax 60,000.00
0.00
31, 500 . 00 ESI
Medical Allowance 10, 500 . 00 SaIary Advance 0.00

Food AIIowance 16,800.00 Phone 0. 00

Personal Allowance 10,500.00 GMC 0 .00

Educatlon Allowance 4,200 .00 Food Coupons 0.00

Monthly performance 27,300.00 Misc . Amount 0.00

210,000.00 60,200.00
Net Pay Rs. One Lal(h Forfy-Nine Thousand Eight Hundred only 149,800.00
)

Generated an I Ogn6no22

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