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Form preview Mci declarationform I have not presented myself to any other Institution as a faculty in the current academic year for the purpose of MCI assessment. am not having private practice anywhere OR practicing at hours of practice are to. Complete details with regard to work experience has been provided nothing has been concealed by me. It is declared that each statement and/or contents of this declaration and /or documents certificates submitted along with the declaration form by the undersigned are absolutely true correct and authentic. In the event of any statement made in this declaration subsequently turning out to be incorrect or false the undersigned has understood and accepted that such misdeclaration in respect to any content of this declaration shall also be treated as a gross misconduct thereby rendering the undersigned liable for necessary disciplinary action including removal of his name from Indian Medical Register. Issued by. Without Photo ID Declaration form will be rejected and will not be considered as teaching faculty 1. e i. Present Designation 1. e i a Certified copies of present appointment order at present institute attached. Department College 1. e iv. City Nature of appointment Regular / Contractual. 1. f Residential Address of employee 1. g Have you undergone Training in Basic Course Workshop at MCI Regional Centre in MET or in your college under Regional Centre observership Yes No If yes give details. NAME OF THE COLLEGE I II III IV Date of Assessment Accepted YES/NO/ABSENT Name of the Assessor Signature of Assessor DECLARATION FORM 2015 2016 - FACULTY 1. a Name. 1. b Date of Birth Age 1. c Recent Passport size photo of the Employee Signed by Dean / Principal of the college. 1. d Submit Photo ID proof issued by Govt* Authorities Photo ID submitted Passport copy / PAN Card / Voter ID / Aadhar Card PHOTOGRAPH TO BE COUTERSIGNED BY THE DEAN/PRINCIPAL Number. Issued by. Without Photo ID Declaration form will be rejected and will not be considered as teaching faculty 1. e i. Present Designation 1. e i a Certified copies of present appointment order at present institute attached* Department College 1. e iv* City Nature of appointment Regular / Contractual* 1. f Residential Address of employee 1. g Have you undergone Training in Basic Course Workshop at MCI Regional Centre in MET or in your college under Regional Centre observership Yes No If yes give details. Name of MCI Regional Centre where Training was done/If training was done in college give the details of the observer from RC Date and place of training 1. h Copy of Passport /Voter Card / Electricity Bill /Telephone Bill / Aadhar Card attached as a proof of residence. 1. i Contact Particulars Tel Office with STD code Tel Residence with STD code E-mail address Mobile Number 1. j Date of joining present institution as Joining report at the present institute attached* Qualifications College University Year Registration No* of UG PG with date Name of the State Medical Council MBBS MD/MS DM/M.
Form preview Declaration contents form Complete a Declaration of Contents and Shipper s Letter of Instruction for each international shipment. DECLARATION OF CONTENTS AND SHIPPER S LETTER OF INSTRUCTION Government regulations require documentation showing specific information for international shipments. The information recorded on this Declaration of Contents and Shipper s Letter of Instruction will be used for customs clearance and the assessment of any applicable duty and tax charged by the destination country. A shipment includes all packages shipped to a single consignee on the same day. Remove this page and follow the steps below when completing the form* The information must be recorded in English or in the language of the destination country. To help ensure the legibility of this multiple-part form please type or use a ball point pen and press firmly. Enter the name and address of the SHIPPER as shown on the address label* Include contact person telephone number and postal code. Enter the SHIPPER S IDENTIFICATION NUMBER FOR CUSTOMS PURPOSES GST ETC. person telephone number and postal/ZIP Code must be included* Enter the CONSIGNEE S IDENTIFICATION NO. FOR CUSTOMS PURPOSES VAT IMPORTER S NO. ETC. if known* Enter the DATE* Enter your reference number s under SHIPMENT REFERENCE NO. if applicable. Enter the NUMBER OF PACKAGES IN SHIPMENT. Enter the TOTAL WEIGHT OF SHIPMENT. Specify lb or kg. 10. When applicable enter the PURCHASER S IDENTIFICATION NO. FOR CUSTOMS PURPOSES VAT IMPORTER S NO. ETC. if known* 11. Enter a complete DESCRIPTION AND VALUE OF CONTENTS* Avoid general terms such as parts paper printed matter etc* Record the CUSTOMS COMMODITY CODE NUMBER HARMONIZED CODE if known* Include the UNIT VALUE and TOTAL VALUE of each commodity. 12. Enter the TOTAL VALUE OF CONTENTS* Customs regulations require that a value be listed for all shipments. For articles of no commercial value a minimum value must be stated* Record Value for Customs Purposes Only in the REMARKS section see 20. 13. Enter any applicable INSURANCE CHARGES Declared Value charges included in the total invoice charges to your customer. 14. Enter any TRANSPORTATION CHARGES included in the total invoice charges to your customer. 16. Specify the CURRENCY you are using for all value entries. 17. Indicate whether or not DUTY TAX AND BROKERAGE SERVICE CHARGES are included in the total invoice value. 18. Enter the COUNTRY OF ULTIMATE DESTINATION* 19. Enter the TERMS OF SALE which define the charges included in the TOTAL INVOICE VALUE see 15. For example CIF Cost Insurance Freight. 20. Indicate in the REMARKS section any special conditions that apply. For example the merchandise is being sent for repair the item is being sent as a gift include each gift receiver s name the values listed are for Customs purposes only etc* 21. UPS provides customs clearance for international Express and Expedited shipments to all destination countries served* Customs clearance of Standard shipments to the United States is performed by a commercial broker usually selected by the consignee.

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