ANNEXURE I
FORM OF MEDICAL CERTIFICATE
(To be signed by Registered Medical Practitioner)
(TO BE SUBMITTED AT THE TIME OF ADMISSION)
I certify that I have carefully examined Sh./Smt./Km.
Son/daughter/Wife of Shri .................................................................................................. whose
signature is given below. As a result of his/her examination I certify that nothing adverse has been
found which may disqualify him/her from admission to a technical institution under the Government
of Delhi. I have to further add that:
1. His/her eyes appear to be
2. His/her heart & lungs are clear
3. His/her weight is
4. His/her height is
5. He/she does not wear glass/wear glass with vision.
6. He/she has not have any disease, mental and bodily infirmity, which will make him/her,
unfit in the near future for an active life and training.
Mark of identification
Signature of the candidate
Name & Signature of the
Medical Officer with seal
& Registration
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ANNEXURE II
CHARACTER CERTIFICATE
(To be submitted at the Time of Admission)
Certified that I know
Son/daughter of
Resident of from the
last s He/she bears a good moral
character and is of .......................... nationality. He/ She is not related to me.
Place:
Signature
Date :
Name (in Capital Letters)
Designation & Address with Stamp
This certificate should be from any one of the following:
1. Principal/Head Master of the recognized School/ College/ Institution where the
candidate studied last;
2. Gazette Officer of Central or State Government;
3. Members of Parliament or State Legislature belonging to the constituency where the
candidate or his parent/ guardian is ordinarily resident;
4. Sub-Divisional Magistrates/ Officers;
5. Tehsildars or Naib/ Deputy Tehsildars authorized to exercise magisterial powers;
6. Block Development Officer;
7. Self-attested certificate by the candidate is also valid.
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ANNEXURE III
PROHIBITION OF RAGGING
(Self-declaration to be submitted at the time of admission)
I, son/ daughter of Sh. resident of
hereby declare that I am aware of the
law regarding prohibition of ragging as well as the punishments, and that, if found guilty of
the offence of ragging and/or abetting ragging, I am liable to be punished appropriately
Place: Signature of the Candidate
Date: Name of the candidate:
I, Father/Guardian of Mr. /Ms
resident of hereby
declare that I am aware of the law regarding prohibition of ragging and I agree to abide by
the punishment meted out to my ward in case the latter is found guilty of ragging.
Signature of Parent/Guardian
Name of Parent/Guardian
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ANNEXURE IV
UNDERTAKING
(To be submitted at the Time of Admission)
1. I am liable to be struck off from the roll of Institution without notice in case I remain absent for
10 consecutive days without information / sanction of leave, unsatisfactory progress in the
training, short of attendance below 50 %, failing in the aptitude test, Committing breach of
discipline in the Institution.
2. I shall get two sets of prescribed uniform stitched within seven days from the day of
reporting at admitted institute positively and shall wear the same daily right from my
residence & till reaching back to the residence.
3. I shall have no objection in attending Institution as per the existing or changed timing by the
institute as per shift timing.
4. I shall maintain at least 80% attendance in each subject for making me eligible for appearing
in the each examination.
5. In case the trade in which I have got admission is not affiliated with National Council of
Vocational Training or de-affiliated by National Council of Vocational Training, DGT, Ministry
of Labor at any stage/reason, I have no objection to appear in the examination conducted
and certified by State Council of Vocational Training.
6. I have no objection if I will be transferred to any other Institute due to any administrative
reason whatsoever.
7. I will not carry/use mobile phone in the ITI campus.
8. I hereby declare that I am aware of the law regarding prohibition of ragging as well as the
punishments, and that, if found guilty of the offence of ragging and/or abetting ragging, I am
liable to be punished as per guideline issued by the Honorable Supreme Court of India .
9. I will attend the Industrial visit / On-Job Training during the training period at various
Industries at my own risk. In case of any accident, mis-happening or riots, I/We will not hold
the Institute/Industry responsible for the same.
In case, I/We fail to abide myself as stated above, the Principal/Head of the Institute is empowered
to take disciplinary action against me as per rules.
Yours faithfully
(Full Signature of Parent/Guardian) (Full Signature)
Name Block Letters) Name ........................................ (Block Letters)
Relation Trade Roll No.
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