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The document is an affidavit by Pradyumna Dasaya, declaring his personal details, Indian passport information, and educational background in MBBS from Karaganda Medical University, Kazakhstan. It states his online study period and the completion of his compulsory internship, affirming the truthfulness of the information provided. The affidavit also includes a verification clause, emphasizing accountability for any false information or documents submitted.

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3 views2 pages

Sos

The document is an affidavit by Pradyumna Dasaya, declaring his personal details, Indian passport information, and educational background in MBBS from Karaganda Medical University, Kazakhstan. It states his online study period and the completion of his compulsory internship, affirming the truthfulness of the information provided. The affidavit also includes a verification clause, emphasizing accountability for any false information or documents submitted.

Uploaded by

nkzsgcjgk9
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd

Note: Affidavit to submit Rajasthan Medical Council office for the purpose of Provisional

Registration/FMG Internship Allotment under Foreign Medical Graduate category.

(The Notaries Affidavit on Non- Judicial stamp Paper (Rs 100/-) with Photo Identity)

I, PRADYUMNA DASAYA son of shri RAGHU NANDAN DASAYA aged 26 (Date of Birth- 02-11-
1999) resident of HN-517 JAMA MASJID KE PICHHE, MANOHAR THANA, JHALAWAR (326037),
(RAJ) Aadhar Card No. 6774-1658-8690 do hereby state/declared on Oath as under:-

[Passport Size Photograph]

1. I say that, I am in Possession of the Indian Passport details given hereunder:

NAME PRADYUMNA DASAYA


PASSPORT NO U4163447
DATE OF ISSUE 06/10/2020 DATE OF EXPIRY 05/10/2030
DATE OF BIRTH 02-11-1999
DETAILS
SR. NO. INDIA TO KAZAKHSTAN TO NO. OF DAYS
KAZAKHSTAN INDIA STAYED IN
RESPECTIVE
COUNTRY
1. 26-12-2020 05-09-2021 254 DAYS
2. 04-08-2022 28-05-2023 298 DAYS
3. 18-08-2023 29-05-2024 286 DAYS
4. 17-08-2024 31-05-2025 288 DAYS

TOTAL DAYS. 1126 Days

2. I say That I have passed my MBBS qualification From KARAGANDA MEDICAL UNIVERSITY
Situated at KARAGANDA, KAZAKHSTAN during the period from 2020 to 2025 and pass out in
the year 2025.

3. I say That I have been done my studies online/partly online from 2021 to 2022 . I will be
completely responsible for the rules set by NMC/RMC for online studies.

4. That I have completed online study period from 2021 to 2022 and also compensated the said
period from 2024 to 2025. from the above said University through offline / physical mode (in-
person). The said information is as follows:

Online Period (in months) Compensated Period (in months)


9 months 9 months
5. That my Compulsory Internship has started from to ........ at affiliated hospital ............ was
completely offline (if internship already done)
6. My Compulsory Rotating Medical Internship is undergoing subject to Embassy/ Board
verification.

7. That all above information and documents given by me are true and correct to my best
knowledge and if, it is found false. I will be completely responsible for action taken against me.

Deponent

Verification

I, the above named deponent do hereby verify that, the contents of para 1 to 7 are true and
correct to my personal knowledge. Nothing has been concealed from my part. If any documents
or information provided are found to be fake or misleading, the student/applicant will be
subject for penalty or legal action. The council staff and officers will not be held responsible for
the same. If students had hidden the information regarding online theory/ clinical training and if
Council found such information in future, then Council shall act as per National Medical
commission guidelines issued from time to time.

Solemnly affirmed at Jaipur on this date 16 of July 2026

Deponent

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