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    Adobe Scan 02-Aug-2023

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    (+91) 9554669695 majorsdsinghaydgmall.

    com
    OS697 290467 info@majorsdspgamc. orß

    MAJOR S.D. SINGH P.G. AYURVEDIC MEDICAL COLLEGE & HOSPITAL


    BEWAR ROAD, FATEHGARH -FARRUKHABAD (U.P.) 209601
    I|chste -www.majorsdspgamc orglaehook Pae - www faccbook com/majorsdsomc
    Appoved by (C IM Newv Delh Deptt of AYUSTI Goyt of Inda. Govt of Uttar Pradesh
    Amlhated by Chhatrapat1ShathuhMabaray Univers1ty Kanpur

    Ref. No.
    .....MSDSPGAMCI2020-21/ Synopsis Date.....

    L.E.C. CLEARANCE CERTIFICATE

    This is to certify that preliminary P.G. Scholar Name. of


    Dept.. Admission year. has represented his/her
    Synopsis infront of I.E.C. on date.. at..... The title of the
    synopsis is..

    The I.E.C. has accepted and approved the present study of preliminary P. G. scholar
    of admission year 2019-20

    Chairperson
    Place...... Institutional Ethical Commmittee.
    CHHATRAPATI SHAHU JI MAHARAJUNIVERSITY
    KANPUR (U.P.)

    "Completed Performa for Registration of Subject (...


    For Dissertation in M.D.(A.Y.)M.S.(AY)
    TITLE

    Investigator

    Supervisor

    Co-Supervisor
    YEAR.
    POST GRADUATE DEPARTMENT OF
    Major S. D. Singh P. G. Ayurvedic Medical College &Hospital
    Bewar Road, Fatehargh, Farrukhabad (U.P.)
    Faculty of Ayurveda
    CHHATRAPATISHAHU JI MAHARAJUNIVERSITY, KANPUR (U.P.), INDIA
    Page 3 of 12
    From,
    Dr

    Preliminary MS. (Ayu )/MDAyu) Schola1


    Department of Post Graduate Studies in
    Major S. D. Singh P. G. Ayurvedic Medical College &Hospital
    Bewa: Road, fatelhgarh, Iarrukhabad (Ur)
    To.
    lhe Registrar,
    C.S.J.M University, Kanpur (U.P.)
    Through
    The Principal/Dean
    Major S.D. Singh P.G. Ayurvedic Medical College &Hospital
    Bewar Road, Fatehgarh, Farrukhabad (U.P)
    Subject: Submission of Completed Prcforma for registration of Synopsis for Dissertation.

    Respected Sir,
    Irequest you to kindly register the below mentioned subject against my name for the submission of
    dissertation to C. S. J. M. University, Kanpur (U.P.) for the partial fulfillnment of M.S. (Ayu.}/M.D.(Ayu} in

    TITLE OF DISSERTATION

    Herewith Iam enclosing completed Proforma for registration of subject for dissertation.
    Thanking you,
    Your Sincerely

    Place :

    Date : Dr. Anshuman Pandey


    CHHATRAPATI SHAHUJI MAHARAJ UNIVERSITY
    KANPUR, U.P.
    "PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION"

    1. Name Ofthe Candidate and Address :

    2. Name of institution :

    3. Course of study and Subject :

    4. Date Of Admission to Centre :

    5. Title of the Topic:


    BRIEF RESUME OF THE INTENDED WORK
    NEED FOR THE STUDY

    REVIEWN OF LITERATURE
    DRUG REVIEW

    PREVIOUS WORK DONE

    OBJECTIVES OF THE STUDY

    1.To Study....

    2. To Evaluate the Role of..


    HYPOTHESIS

    MATERIAL AND METHODS

    SOURCE OF DATA

    SELECTION CRITERIA

    INCLUSION CRITERIA

    EXCLUSION CRITERIA
    PARAMETERS FOR ASSESMENT

    SUBJECTIVE PARAMETER :

    OBJECTIVE PARAMETER :

    STATISTICAL ANALYSIS:

    Does the study require any investigations or intervention to be


    conducted on patients or other Humans or Animals?
    If so, Please describe briefly.
    INSTITUTION:

    YOUR
    FROM
    OBTAINED

    BEEN
    CLEARENCE
    -
    REFERENCES:

    ETHICAL

    OF
    HAS LIST
    SIGNATURE OF THE CANDIDATE Dr.

    REMARKS OF THE GUIDE

    NAME AND DESIGNATION OF GUIDE:

    SIGNATURE

    CO-GUIDE

    SIGNATURE

    HEAD OF DEPARTMENT

    SIGNATURE

    REVARKS OF THE PRINCiPAL

    SIGNATURE

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