updating checklist affirmation forms

8/11/2019 Updating CheckList Affirmation Forms

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Indian Institute of Technology Madras

M.Tech. Admission for Academic Year 2014-2015

Form for Reporting for Admission and Request for Updation

Name of the Candidate:

M.Tech. Application No.:

Programme Offered:

Roll No.:

I hereby report to attend the Admission for M.Tech. programme at IIT Madras for the

academic year 2014-2015 scheduled on 21st July, 2014 (Monday).

I wish to be considered for updating to programme(s) of my higher preference(s)

indicated in my application, if vacancy arises. I understand that it is mandatory

that I should take the discipline and stream allotted to me as a result of updating.

(Strike out the above paragraph, if you do NOT want updation. The updation is

NOT applicable for the candidates who have got the offer of admission to programmes

of their first preference.)

Date: 21st July, 2014 Signature of the Candidate

Note: The results of updation will be displayed at 5 p.m. on 22nd July, 2014 (Tuesday) at

Student Activities Centre (SAC) and GATE Office.



M.Tech.2014

M.Tech. AdmissionIndian Institute of Technology Madras

CHECK LIST

Roll No.

1. Candidate’s Name

2. M.Tech. Appln. No. 3. Gender 4. Category 5. PwD Yes No

6. Date of Birth 7. Nationality 8. Married Unmarried

9. Blood Group Rh+

(Tick + or – as the case may be) Example A+

- -

10. Programme(allotted)

Code Programme Name

11. Permanent Address: Local address (Guardian, if any) Guardian’s Name:

PIN Code PIN Code

Phone No. with STD Code Phone No. with STD Code

Mobile No. Mobile No.

12. Documents to be produced (Original and attested copies – original to be returned after verification).Please arrange these in the following order:

S.No Details Yes No Remarks

(i) First page of SSLC/SSC/Matriculation

(ii) Birth Certificate

(iii) Degree/Provisional certificate

Grade cards/Mark sheets of all the semesters/Consolidated Mark list

(iv) Declaration signed by parent/guardian

(v) Medical fitness certificate

(vi) Course completion certificate

(vii) If currently employed, relieving order from the employer

(viii) Community CertificateFor SC / ST : (i) SC/ST Certificate

For OBC : (ii) OBC (Non Creamy Layer) Certificate

(ix) Person with Disability (PwD) certificate, if applicable

(x) Original GATE Scorecard (if not submitted already)

(xi) Details of Fee paid

(xii) “Solemn Affirmation of Conformance to Rules and Regulations” Form

13. Hostel Name & Room No. 14. Email ID

Date: Signature of candidate--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

For Office use onlyVerified & found correctOriginal GATE Scorecard Stamped

Assistant Assistant Registrar (Academic)



INDIAN INSTITUTE OF TECHNOLOGY MADRAS

Office of Dean (Students)

SOLEMN AFFIRMATION OF CONFORMANCE TO RULES AND REGULATIONS(to be submitted by all Student of I IT Madras)

I, Mr. / Ms .........................................................................................................

(all capital letters)

Assigned with Roll No ............................ , am the son/daughter/ward of

Mr. /Ms ............................................................................................................

(all capital letters)

residing at Door No ............................... House No...................................................(all capital letters)

Street Name: .....................................................................................................(all capital letters)

Local Area Name: ................................................................................................(all capital letters)

Village/Town/City Name: ....................................................................(all capital letters)

State: .............................................................................. PIN Code: ------------------(all capital letters)

am joining as a student in the Department of-----------------------------------------------------------

I hereby declare that, I:

a)

have read and understood the prevailing rules and regulations of the Institute1 and the Hostel

Management2;

b)

am aware of (i) the national laws pertaining to ragging, (ii) the serious consequences of involvement inragging, and (iii) the administrative, legal and penal actions that will be imposed on persons

apprehended, tried and convicted of these acts; and

c)

am aware of the ban on the possession and/or use of any powered vehicles by students inside the IIT

Madras Campus.

Keeping the above in mind, I SOLEMNLY AFFIRM that:a) I SHALL sincerely obey the prevailing rules and regulations of IIT Madras, my Institute;b) I SHALL NOT indulge in ragging, nor will encourage, abet, or be indifferent towards others engaging in

ragging; and, on the contrary, will work to ensure the dignity, honour and self-esteem of all students;

c)

I SHALL NOT possess and/or use any powered vehicle inside the IIT Madras campus, except with the due

permission, if applicable;

d) I SHALL NOT possess any banned substances / materials during my entire stay at IIT Madras premises; and

that

1

understand that if I am found violating or to have violated any of the rules and regulations pertaining to

students of IIT Madras, I am liable to obey the rulings of the respective Official Authorities or Committees of

IIT Madras and/or pay the penalty specified by them.

Signature of the Student Counter signed by Parent / Guardian

Place: IIT Madras

Date: