Note: Proceed with this Self -declaration only if you are a Registered Nurse or a Doctor
For the purposes of being considered eligible to undertake the ‘Essential Upskilling for Nurses on
COVID-19 Pandemic Management’ provided by Trained Nursing Association of India and Columbia
Asia [•] (herein referred to as the Course), I confirm and declare that:
am a (i) qualified, trained and registered Nurse or (ii) a qualified, trained, registered
& practicing Medical Doctor, and
I have never been disqualified by authority or court of law under any applicable law
or regulation from pursuing the vocation/profession of Nursing or the profession of
am of sound mind and am above 18 years of age as on the date of making this
am not currently undergoing or under notice or assertion of any criminal
prosecution or other criminal or professional misconduct investigation
I understand clearly that every effort has been made by the Curators of this Course to
ensure that the content thereof is factually correct and is reasonably updated to current
dates and is based on and aligned with the advisories issued by World Health Organisation
(WHO), Indian Council of Medical Research (ICMR) and Centres for Disease Control (CDC).
I understand clearly that the application or use of this knowledge by me must (i) conform to
the highest standards of care and professionalism ensuring always and uncompromisingly
the adherence to the professional requirements attaching to the profession of Nursing and
as appropriate to the profession of Medicine (ii) be used by me with utmost care in
conjunction with knowledge gained by me during my degree, experience and knowledge
gained during the profession.
I understand and appreciate that the Course has been designed and is offered without any
monetary consideration or participation fee on a good faith basis in public interest.
I hereby solemnly and truthfully declare that the statements/disclosures made, and information
submitted herein (collectively Information) and undertakings provided herein are individually and
collectively true and accurate to the best of my knowledge and belief. I understand if the
Information shared by me is found to be incorrect or false or not fully true at any stage, my
candidature in the course will be cancelled with immediate effect.
I hereby indemnify and shall keep indemnified and held harmless at all times in future and without
limitation as to time and amount, Columbia Asia, Trained Nurses Association of India, Generation
India Foundation and all other Partners and persons who have played any part or role in creating
the Course against any cost, liability, reputational damages or any other consequence whatsoever as
may directly or indirectly arise to or be asserted against them either individually or collectively on
account of any act of omission or commission taken by me in my personal or professional capacity
whether in course of my work or otherwise and whether related to COVID 19 or otherwise.
Agreeing to this statement is legal consent to all statements mentioned on this page and shall be
enforceable against me under the law of contract or other applicable law in India.