AFFIDAVIT BY THE STUDENT Prevention of Ragging

I__________________________Roll No. ________________Branch_________________ S/o. D/o. ____________________________________ having been admitted to Kurukshetra Institute of Technology & Management, Bhor-Saidan, Pehowa Road, Kurukshetra-136118, have received a copy of the UGC Regulations on Curbing the Menace of Ragging in Higher Educational Institutions ( hereinafter called the Regulations), carefully understood the provisions contained in the said Regulations. 2. 3. I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes ragging. I have also in, particular, perused clause 7 and clause 9.1 of the Regulations and am fully aware of the penal and administrative action that is liable to be taken against me in case I am found guilty of or abetting ragging, actively or passively, or being part of a conspiracy to promote ragging. I hereby solemnly over and undertake that: I will not indulge in any behavior or act that may be constituted as ragging under clause 3 of the Regulations.\ I will not participate in or abet or propagate through any act of commission or omission that may be constituted as ragging under clause 3 of the Regulations. I hereby affirm that, If found guilty of ragging, I am liable for punishment according to clause 9.1 of the Regulations, without prejudice to any other criminal actions that may be taken against me under any penal law or any law for the time being in force. I hereby declare that I have not been expelled or debarred from admission in any institution in the Country on account of being found guilty of, abetting or being part of a conspiracy to promote, ragging, and further affirm that, in case the declaration is found to be untrue, I am aware that my admission is liable to be cancelled.

4. a. b. 5.

6.

Declared this _________day of ____________ month of 20___ Signature of Deponent

VERIFICATION Verified that the contents of this affidavit are true to the best of my knowledge and no part of the affidavit is false and nothing has been concealed or misstated therein. Verified at _______________________ on this the _________day of _____________month, 20___

Signature of Deponent

Solemnly affirm and signed in my presence on this the ____________day of ____________month 20___after reading the contents of this affidavit

District Notary

AFFIDAVIT BY THE PARENTS OF THE STUDENT Prevention of Ragging

I_____________________________R/o____________________________ __________________father of /Guardian of _________________________ Roll No._____________ _ Branch______________ having been admitted to Kurukshetra Institute of Technology & Management, Bhor- Saidan, Pehowa Road, Kurukshetra-136118, have received a copy of the UGC Regulations on Curbing the Menace of Ragging in Higher Educational Institutions ( hereinafter called the Regulations), carefully understood the provisions contained in the said Regulations. 2. 3. I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes ragging. I have also in, particular, perused clause 7 and clause 9.1 of the Regulations and am fully aware of the penal and administrative action that is liable to be taken against me in case I am found guilty of or abetting ragging, actively or passively, or being part of a conspiracy to promote ragging. I hereby solemnly over and undertake that: a. b. 5. My ward will not indulge in any behaviour or act that may be constituted as ragging under clause 3 of the Regulations.\ My ward will not participate in or abet or propagate through any act of commission or omission that may be constituted as ragging under clause 3 of the Regulations.

4.

I hereby affirm that, If found guilty of ragging, my ward is liable for punishment according to clause 9.1 of the Regulations, without prejudice to any other criminal actions that may be taken against my ward under any penal law or any law for the time being in force. I hereby declare that my ward has not been expelled or debarred from admission in any institution in the Country on account of being found guilty of, abetting or being part of a conspiracy to promote, ragging, and further affirm that, in case the declaration is found to be untrue, I am aware that my ward's admission is liable to be cancelled.

6.

Declared this _________day of ____________ month of 20___ Signature of Deponent Name__________________________________________ Address________________________________________ _______________________________________________

Verification Verified that the contents of this affidavit are true to the best of my knowledge and no part of the affidavit is false and nothing has been concealed or misstated therein. Verified at _______________________ on this the _________day of _____________month, 20___

Signature of Deponent

Solemnly affirm and signed in my presence on this the ____________day of ____________20___ after reading the contents of this affidavit

District Notary

CERTIFICATE OF MEDICAL FITNESS

(For admission to Engineering/Degree Courses in Haryana)

To be obtained only from Gazetted Government Medical Officer/Medical Officer of a Government Undertaking. Please note that this certificate in no other form will be accepted. Medical Certificates issued by private medical practitioners will not be accepted. (Please refer to prescribed standards given overleaf ) Name _________________________________________________________________________________________ (in Block Letters) Father's Name Sh.________________________________________________________________________________

Height:-_________________________________________ Weight _________________________________________

Chest __________________________________________________________________________________________

Heart & Lungs ___________________________________________________________________________________

Vision:L: ___________________________________________ R:___________________________________________

Colour Vision: ___________________________________________________________________________________

Hearing________________________________________________________________________________________

Hernia/Hydrocele/Piles: ___________________________________________________________________________

Remarks: _______________________________________________________________________________________

I certify that I have carefully examined Sh./Km./Smt. _____________________________________ Son/daughter of Shri _____________________________________ who has signed in my presence.

He/She has not mental and physical disease and is FIT.

Signature of the Candidate

Signature of the Medical Officer with legible seal

Station:_____________________________________

Date:_______________________________________

HEIGHT

Not less that 1.5 metre for male candidates, not less that 1.2 metre for female candidates.

WEIGHT

41 Kg. approximately for male candidates and 37Kg. approximately for female candidates.

CHEST MEASURERMENT

Not less than 69 cms. With satisfactory limit of expansion and contraction for male candidates only.

HEART & LUNGS HEARNIA, HYDROCELE

: :

No abnormality. Presence of these is a temporary disqualification to be & rectified before joining the course of study.

VISION

Normal, where defective, it must be corrected to 6/9 in the better eye and 6/12 in the worse eye. Eye should be free from congenital and other disease. In case of admission to Mining Engg. Textile Technology & Textile Chem., the candidates must also be free from colour blindness ( inability to distinguish between principal colours).

HEARING

Normal, where defective, it must be corrected.

KURUKSHETRA INSTITUTE OF TECHNOLOGY & MANAGEMENT

Bhor-Saidan, Pehowa Road, Kurukshetra
Approved by AICTE, Govt of Haryana & affiliated to Kurukshetra University, Kurukshetra Ph. No. : 01741-283841-42 Fax No.: 01741-283843 Stapple Website: www.kitm.in E-mail: kitmkkr@gmail.com, 4 recent An ISO 9001:2000 Certified Institute

ADMISSION FOR B.Tech. (I/III Sem)/MBA

(Tick as applicable) Session 20_________

passport size Photographs

1.

Name in Full (in Block Letters) as in qualifying exam

Fathers (i) Name (in Block Letters) as in qualifying exam (ii) Occupation

Paste One recent passport size photograph

3 4

Mothers Name (in Block Letters) Date of Birth (As per Matric Certificate) Nationality Regn. No. (if registered with Kurukshetra University) Category to which belong (Tick Category) Permanent Address (With pin code) Phone No. (with STD Code) Mob. No. (Student) Mob. No. (Parents) Gen/SC/BC-A/BC-B/OBC/ESM/PH/FF

5 6

7 8

Correspondence Address (with pin code) Phone No. (with STD Code) Mob. No. (Student) Mob. No. (Parents)

10

AIEEE/LEET/MAT/Roll No. Tick which is applicable

Roll No. Rank No.

11

Annual Income of Parents

Rs..per year

12. Details of Qualifying Examination Examination Passed Board/University Passing Year Subjects Obtained Mathematics Physics 10+2 English Chemistry/Biology Bio-Tech/Comp. Hindi Total Diploma in ___________Engg. Graduation Any other Detail of Marks Max/Marks %age

13. Details of compartment, if any, ___________________________________________________________________ 14. Is there any gap between studies after qualifing Exam _____________ Yes/No ___________ (if yes, attach affidavit) 15. Ever disqualified from studies __________________Yes/No 16. Name & Address of Local Guardian if any ___________________________________________________________ Relationship __________________________ Ph. No. _________________________ Mobile _____________________

Declaration I, hereby, declare that the statements made in this Application Form are true to the best of my knowledge and belief. I clearly understand that if any of the information is found incorrect, or false, my admission is liable to be cancelled. I fully agree to abide by the rules and regulations of the Institute regarding attendance, discipline and payment of fees.

___________________________ Signature of the Parent/Guardian

___________________________ Signature of the Candidate

Date: ___________________

UNDERTAKING

I, hereby, undertake:1. 2. That I shall abide by the rules & regulations of the Institute that may be in force from time to time. That during my stay in the Institute, I shall not take part in any subversive activity or in any act of indiscipline and if found indulging in such activity, my admission is liable to be cancelled. That I shall attend the classes in the Institute regularly right from the beginning, failing which my admission shall be cancelled without any notice. That I understand that consequent upon the withdrawal/cancellation of admission, the fee paid will be refunded as per rules. That I agree that the decision of the Director-Principal in all the matters concerning my admission, studies, discipline and conduct will be final and binding upon me. That I will make all payments in time as notified by the Institute from time to time. and if at any time, the fee structure is revised/enhanced by the competent authority, the revised/enhanced amount would be deposited by me with the Institute. That if at any stage, I am declared ineligible and if my admission is cancelled by the University will have no claim whatsoever against the Institute/University/State Govt. ab-initio under the rules, I

3.

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7.

8.

That I clearly understand that ragging is an offence and punishable under the law of the land. I shall never directly or indirectly indulge in any act of ragging. In case of any involvement, I clearly understand that serious action which may lead to the expulsion from the Institute may be taken besides other legal action by the Institute authorities as they deemed fit.

ELIGIBILITY UNDERTAKING
"I hereby solemnly affirm and declare that the information provided by me in the Admission Form is correct and I have not concealed any relevant facts. I undertake to abide by all the rules and instructions of the Kurukshetra University, State Govt. and the Institute. I am taking admission in the Institute provisionally at my own risk and responsibility subject to the confirmation of my admission by the Kurukshetra University. If at any stage, I am declared ineligible and if my admission is cancelled by the University. ab-initio under the rules, I will have no claim, whatsoever, against the Institute/University/

Signature of the Parents/Guardian

Signature of the Candidate

DATE: __________________________

FATHER'S/GUARDIAN'S UNDERTAKING
1. I guarantee that my son/daughter/ward ________________________(name) admitted to the Kurukshetra Institute of Technology & Management ,Kurukshetra will maintain good behaviour and strict discipline and will not take part in any activity of mis-conduct and indiscipline. 2. I undertake that my son/daughter/ward will join the Institute right from the beginning and attend the classes regularly. It is explicitly understood that the admission of my son/daughter/ward would stand automatically cancelled without any notice if he/she does not attend the classes regularly. I undertake that I will make all payments of fees and other dues whatsoever in respect of my son/daughter/ward to the Institute well in time as per the schedule notified by the Institute. I further undertake that I will be in touch with the Institute in connection with the performance/progress in studies, attendance and semester results of my ward. I shall be visiting the Institute at least twice a semester to monitor the performance of my ward. It is further understand that consequent upon the withdrawal/cancellation of admission, the fee paid will be refunded as per rules. I clearly understand that my son/daughter/ward will abide by all the rules and regulations of the Institute as well as of the University as applicable from time to time. I clearly understand that ragging is an offence and punishable under the law of the land. I undertake that my son/daughter/ ward will not directly or indirectly indulge in any act of indiscipline or ragging. In case of involvement, strict action leading to the expulsion from the Institute besides legal action may be taken by the Institute as deemed fit.

3. 4.

5. 6. 7.

Place: Kurukshetra Date: __________ Signature of Father/Guardian Address:-

For Admission Committee

Particulars checked and found correct. Admitted in _______________________________________ Branch.

_______________________ Signature

_______________________ Signature

_______________________ Signature

Fees paid vide Receipt No.____________________dated __________________ through CASH/CH/DD ______________________________________________

Authorized Signatory