AUTHORITY LETTER

I,

_________________________________________________________ Son / Daughter / Wife

_____________________________________________________________ bearing

Merit

No.

represent

Mr.

________in

NRI quota seats for admission to MBBS course 2012 - 2013 do hereby authorize
___________________________________________to

of

Mr/Mrs/Miss

me on ________(date) before the

Admission Committee for admission to MBBS course 2012 2013 (NRI quota seats). The signature and the
photograph of above named Mr/Mrs/Miss _____________________________ are attested below.

Photo of
candidate

Signature of Candidate
Name ______________________________
Merit No. ____________________________

Signature

of

Authorized

Photo of
authorized
proxy

Proxy

Signature of Candidate

UNDERTAKING
I, ___________________________________________________________ Son

Daughter

Shri____________________________________________, aged _______ years,

Wife

having

of

Merit

No._____________ in NRI quota seats for admission to MBBS course 2012 - 2013 do hereby solemnly affirm
and undertake that the decision of my authorized proxy, Mr./ Mrs. / Miss regarding selection of seats in interview
on ___________ (date) 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 on _______________ (date).
Signature of candidate _______________________
Merit No. _________________________________
Address ________________________________