ANNEXURE-VII

CERTIFICATE OF MEDICAL FITNESS

(For admission to B.E./B. Tech. and B. Arch. Courses in Haryana)

To be obtained only from gazette 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.

Space
For
Photograph

I certify that I have carefully examined Mr./Ms.*______________________________________________

Son/Daughter of Shri __________________________________________________________ whose signature is

given below. Based on the examination, I certify that he/she is in good mental and physical

health and is free from any physical defects which may interfere with his/her studies

including the active outdoor duties required of a professional.

Marks of Identification________________________________________________________________________

Signature of Candidate________________________________________________________________________

Place:

Date:

Name & Signature of the Medical Officer with Seal

*Strike whichever is not applicable. and registration number

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 ANNEXURE-VIII
UNDERTAKING BY THE STUDENT
I, (full name of student with admission/registration/enrolment number) s/o d/o Mr. /
Mrs./Ms:……………………………………………………………………………………………having been admitted
to …………………………………………………………(name of the institution) …………………......................
have received a copy of the AICTE Regulation dated 1.7.2009 on Curbing the Menace of
Ragging in Higher Educational Institutions, ( hereinafter called the “ Regulation”) carefully
read and fully understood the provisions contained in the said Regulations.
1) I have, in particular, perused Clause 4 of the Regulation and am aware as to what
constitutes ragging.
2) I have also, in particular, perused Clause 5(3) and Clause 8(4)(a) of the Regulation
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 4 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 4 of the Regulations.
4) I hereby solemnly affirm that, if found guilty of ragging, I am liable for punishment
according to clause 8(4)(a) 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:………………………………

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 ANNEXURE-IX
UNDERTAKING BY PARENTS/GUARDIAN
1) I, Mr. /Mrs./Ms. ………………………………………………………………..………………… (Full name of
Parent /Guardian) father/mother/guardian of Mr./ Mrs./ Ms.…………………….………………
(Full name of student with admission/registration/enrolment number)
………………………………….. having being admitted to ……………………………….. (name of the
institution) ………………………………., have received a copy of the AICTE Regulation on
Curbing the Menace of Ragging in Higher Educational Institutions, 2009, (hereinafter
called the “Regulation”) carefully read and fully understood the provisions contained
in the said Regulations.
2) I have, in particular, perused Clause 4 of the Regulation and am aware as to what
constitutes ragging.
3) I have also, in particular, perused Clause 5(4) and Clause 8(4) of the Regulation 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) My ward will not indulge in any behavior or act that may be constituted as ragging
under Clause 4 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 4 of the Regulations.
5) I hereby solemnly affirm that, if found guilty of ragging, my ward is liable for
punishment according to Clause 8(4) (a) 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 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 the admission of my ward is liable to be
cancelled.
Declared this …………….... day of…………………. month of ………………….year…………………

Signature of Parents/Guardian

Name: ……………………………………………………...

Address: ……………………………..……………………

Mobile No./Tel. Phone: ……………………………..

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