Annexure-3

(To be submitted on a Non-Judicial Stamp Paper of Rs. 10/- or nearest higher amount duly notarized)

INDIAN INSTITUTE OF INFORMATION TECHNOLOGY ALLAHABAD

UNDERTAKING BY CANDIDATE FOR DOCUMENTS SUBMISSION

I……………………………………………………………………………Son/Daughter of……………………………………………………………………

Resident of……………...………………………………………………………………………..aged…………………………years hereby execute

this undertaking on ….../…... / 20_ _ that the documents which I have uploaded for Online provisional admission
are true to the best of my knowledge and if on subsequent physical verification any discrepancy is
found/observed, my provisional admission to B.Tech./M.Tech./ MBA & Dual Degree M.Tech. Ph.D. program shall
be cancelled forthwith.

Note: Candidates who has appearing in final examination:

If my minimum eligibility criteria of percentage of marks, or any other minimum eligibility criterion are observed
as not having met at any stage, my provisional admission to B.Tech./M.Tech. / MBA & Dual Degree M.Tech.-Ph.D
program shall be treated as cancelled forthwith. All responsibility in this respect lies on me.

Date:

Place:

Counter Signed by: (Candidate`s Signature)

Father/Mother: __________________ Name: ___________________________________

Name: _________________________ GATE/CAT/MAT/XAT/GMAT/CMAT/JEE Application No.:

Address: _______________________ ________________________

_______________________________ Program: _________________________________

Phone/Mobile No.: _______________ Permanent Address: ________________________

Aadhar No.: ____________________ Mobile No: ________________________________

Aadhar No.: _______________________________

 (Annexure -4 )
Undertaking by the Student (As per UGC Regulations on Curbing the Menace of Ragging
in Higher Educational Institutions, 2009)

(To be submitted on a Non-Judicial Stamp Paper of Rs. 10/- duly notarized by the Oath Commissioner)

1) I,………………………………………………………………………………………………….. (full name of

studentwithadmission/registration/enrolmentnumber)s/o,/d/oMr./Mrs./Ms.
…………………………………………, having been admitted to (name of the institution) , 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.
2) I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes
ragging.
3) 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.
4) I hereby solemnly aver and undertake that
a) I will not indulge in any behaviour 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.
5) 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.
6) 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 deponent

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 (place) on this day of Month of the Year.

Signature of deponent

Solemnly affirmed and signed in my presence on this the (day) of (month) ,

(year ) after reading the contents of this affidavit.

OATH COMMISSIONER
 (Annexure - 5 )
Undertaking by the parent/guardian (As per UGC Regulations on Curbing the
Menace of Ragging in Higher Educational Institutions, 2009)

(To be submitted on a Non-Judicial Stamp Paper of Rs. 10/- duly notarized by the Oath Commissioner)

1) I, Mr./Mrs./Ms. (full
name of
parent/guardian) father/mother/guardian of , (full name of student with admission/registration/enrolment
number) , having been admitted to (name of the institution) , 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.
2) I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes
ragging.
3) 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.
4) 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.
5) 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.
6) 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 this day of month of year.

Signature of deponent

Name:

Address:
Telephone/Mobile No.:

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.

(place) on Month of Year

Verified at this day of the .

Signature of deponent

Solemnly affirmed and signed in my presence on this the (day) of (month) , (year )
after reading the contents of this affidavit.

OATH COMMISSIONER
 Annexure - 6

OBC Undertaking

Declaration / undertaking - for OBC Candidates only

I, son/daughter of Shri
resident of village/town/city district State hereby
declare that I belong to the community which is recognised as a
backward class by the Government of India for the purpose of reservation in services as per orders
contained in Department of Personnel and Training Office Memorandum No.36012/22/93‐ Estt.
(SCT),dated 8/9/1993. It is also declared that I do not belong to persons/sections(Creamy Layer)
mentioned in Column 3 of the Schedule to the above referred Office Memorandum, dated 8/9/1993, which
is modified vide Department of Personnel and Training Office Memorandum No.36033/3/2004 Estt.(Res.)
dated 9/3/2004. I also declare that the condition of status/annual income for creamy layer of my
parents/guardian is within prescribed limits as on financial year ending on March 31, 20_ _.

Place: Signature of the Candidate*

Date:

*Declaration/undertaking not signed by Candidate will be rejected