I.

Medical Certificate ANNEXURE-I

CERTIFICATE OF MEDICAL FITNESS

(For admission to Professional Courses)

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 no mental and physical disease and is FIT.

Signature of the candidate

Station: .................................... Signature of the Medical Officer

With legible seal.
Date : ....................................

========================================================================
PRESCRIBED MEDICAL STANDARDS FOR ADMISSION

An Engineering profession demands good physique and stamina. An applicant who suffers from any organic defect or
does not have sound health so as to bear the strain of the course which must be heightened in his/her professional life
would be well advised not to take up the Engineering Profession. He/she must fulfil the following medical standards:
a) HEIGHT: Not less than 1.5 metre for male candidates, and not less than 1.2 metres for female candidates.
b) WEIGHT: 41 kg. Approximately for male candidates and 37 Kg. approximately for female candidates.
c) CHEST MEASUREMENT: Not less than 69 cms. with satisfactory limit of expansion and contraction for male
candidates only.
d) HEART & LUNGS: No abnormality.
e) HERNIA, HYDROCELE: Presence of these is a temporary disqualification to be & rectified before joining
the course of study.
f) 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).
g) HEARING: Normal, where defective, it must be corrected.
II. Anti Ragging Affidavit ANNEXURE-II

AFFIDAVIT BY THE STUDENT

I, Mr./Ms ___________________________________ Course:________ Branch _____________

Year _________ Dept _______________________ S/o D/o Mr./Ms. _________________________
, having been admitted to Haridwar University, Roorkee have received a copy of the UGC
Regulations on Curbing the Menace of Ragging in Higher Educational Institutions, 2009,
(hereinafter called the “Regulations”) carefully read and fully understood the provisions contained in
the said Regulations.
1. I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes
ragging.
2. 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.
3. I hereby solemnly aver and undertake that
a) I will not indulge in any behavior or act that may be constituted as ragging under clause 3 of the
Regulations.
b) 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.
4. 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 action that may be taken against me under
any penal law or any law for the time being in force.
5. 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.

Declared this ___ day of ____________ month of ______ year

Signature of Student
Name:

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 ___ day of ____________ month of ______ year
Signature of Student
Solemnly affirmed and signed in my presence on this ___ day of ____________ month of ______
year after reading the contents of this affidavit.
Signature of Parent
OATH COMMISSIONER
 AFFIDAVIT BY PARENT/GUARDIAN

I, Mr./Ms ___________________________________ Enrolment No _____________of class

(Program)________ Branch _________________________ Year _________ Dept ____________
s/o d/o Mr./Ms. ____________________________________________, having been admitted to
Haridwar University, Roorkee, have received a copy of the UGC Regulations on Curbing the
Menace of Ragging in Higher Educational Institutions, 2009, (hereinafter called the “Regulations”),
carefully read and fully understood the provisions contained in the said Regulations.
1. I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes
ragging.
2. 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 my ward in case he/she is found
guilty of or abetting ragging, actively or passively, or being part of a conspiracy to promote ragging.
3. I hereby solemnly aver and undertake that
a) My ward will not indulge in any behaviour or act that may be constituted as ragging under clause
3 of the Regulations.
b) 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 action that may be taken
against my ward under any penal law or any law for the time being in force.
5. 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, the admission of my
ward is liable to be cancelled.

Declared on this ___ day of ____________ month of ______ year

Signature of Parent
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 ___ day of ____________ month of ______ year
Signature of Parent

Solemnly affirmed and signed in my presence on this ___ day of ____________ month of ______
year after reading the contents of this affidavit.

OATH COMMISSIONER
III . Haridwar University Undertaking ANNEXURE-III

UNDERTAKING
I declare that I am fully responsible for my own conduct, behaviour and safety if I depart the
Haridwar University (HU) premises on my own initiative, with or without permission. I will not hold
Haridwar University responsible if I experience an unforeseen accident/conduct. In addition, I
consent to informing Haridwar University (HU) Roorkee whenever I make a visit outside of the
university's boundary.

Student Name:
Course: Branch: Year:
Signature:

IV. Undertakings

UNDERTAKINGS
1. Undertaking of Awareness of medical facilities at Haridwar University, Roorkee.
I _____________________________ parent/guardian of Mr. /Ms.__________________
branch______________________________year_____ hereby declare that the following in respect of
my ward to be admitted to _________________degree programme at HU Roorkee. I am aware of the
following facts:
i) It is the responsibility of the guardians to provides the basic medicines kit as per student medical
issues (prescribed by their own doctors)
ii) It is the responsibility of the guardians to take their wards for outside treatment.
iii) In case of emergency, I hereby authorize the panel of doctors identified by HU Roorkee to take
decisions in connection with medicine/surgical treatment in the best interest of my
son/daughter/ward. Despite the best efforts on the part of HU Roorkee if anything untoward happens
to my ward, I shall not hold the university accountable for the same and will not seek any financial
help or compensation for the same through any court of law.

Date:
Signature of Parent/Guardian:
2. Undertaking by the student for not using motor driven vehicles:
I _______________________________son/daughter/ward of Mr. / MS. _______________ hereby
give an undertaking that I will not drive any motor driven vehicle in or near the institute premises
during my stay at Haridwar University. If at any stage I am found to violate the above undertaking
my hostel seat will stand automatically cancelled without assigning any reasons.

Date:
Counter signature of parent/guardian:
Signature of the student:

3. Undertaking for not indulging in any kind of ragging and indecent behavior towards
juniors/fellow student
I _______________________________son/daughter/ward of Mr. / Ms. _______________ hereby
give an undertaking that I will not indulge in any act of ragging towards my junior students or
indecent behavior or passing indecent SMS, email, Social Media etc to fellow students during my
entire stay at Haridwar University, Roorkee. I am aware that ragging is a criminal offence. Also, I
am aware of the fact that if at any stage I am found to violate the above undertaking the Haridwar
University, Roorkee authorities may take suitable action that may include filing a police complaint
and expelling me from the Institute. I will not challenge the action taken by the Institute for such
violation in any court of law.

Date:
Counter signature of parent/guardian
Signature of the student
4. Undertaking by the student for not playing in water body areas.
I _______________________________son/daughter/ward of Mr. / MS. _______________ hereby
give an undertaking that I will not play in any water body area without prior permission from the
Institute. If I am found to violate the above undertaking and if anything untoward happened to me,
I/my parents/guardians shall not hold the Institute accountable for the same and will not seek any
compensation for the same from any court of law and the Haridwar University, Roorkee may take
suitable action that includes expelling me from the campus without assigning any reason.

Date:
Counter signature of parent/guardian
Signature of the student

5. Undertaking by the student to abide by Code of Conduct of HU Roorkee

I ____________________________ son/daughter/ward of Mr./Ms._______________________
have read and understood the Students code of conduct of HU, Roorkee. I accept and agree to
wholeheartedly abide by letter and spirit, in case I am found to violate any of the code of conduct I
will accept the punishment decided by university authorities including expulsion. I will not challenge
the action taken by the University for such Violation in any court of law.

Date:
Counter signature of parent/guardian:
Signature of the student:

6. Undertaking by the student to abide by Hostel Code of Conduct of HU Roorkee

I____________________________son/daughter/ward of Mr./Ms. ________________________have
read and understood the Students Hostel code of conduct of HU, Roorkee. I accept and agree to
wholeheartedly abide by letter and spirit, in case I am found to violate any of the Hostel code of
conduct. I will accept the punishment decided by university authorities including expulsion. I will
not challenge the action taken by the University for such Violation in any court of law.

Date:
Counter signature of parent/guardian
Signature of the student