Consent form for becoming a visitor/inspector
Professors / Associate Professors of Govt. Colleges consented for being Visitor/ inspector
Name of the Govt. College
System of Medicine
Name of the State
Your answer
Name of the teacher
Your answer
Current Designation of the teacher
Your answer
Current Department of the teacher
Your answer
Teacher Code issued by CCIM to the teacher
Your answer
Nature of appointment of the teacher
Vigilance Clearance of the teacher
Previous experience (1) Write "-NA-" if not applicable
Name of the college previously worked (with date From / to)
Your answer
Previous experience (2) Write "-NA-" if not applicable
Name of the college previously worked (with date From / to)
Your answer
Previous experience (3) Write "-NA-" if not applicable
Name of the college previously worked ( with date From / to)
Your answer
Previous experience (4) Write "-NA-" if not applicable
Name of the college previously worked ( with date From / to)
Your answer
Previous experience (5) Write "-NA-" if not applicable
Name of the college previously worked (with date From / to)
Your answer
Previous experience (6) Write "-NA-" if not applicable
Name of the college previously worked (with date From / to)
Your answer
Mobile No.
Your answer
Email ID
Your answer
Consented for being a visitor/inspector
Teacher's consent to be a visitor/inspector to visit the ASU college as and when required by the CCIM or M/o AYUSH, Govt. of India
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