MERI STUDENTS’ WELFARE
APPLICATION FORM
(For the students participating in Educational cum Industrial Tour/Industrial Visit/ Study tours/ Field
visit/Trips/excursion activity/or any other visit.)*
1. Name of the Camp/Trip - ____________GOA TRIP_________________________
2. Dates of Trip/Camps/Course -___ April- April 2025_______________________
3. Name of the Applicant - ___________________________________________
Affix Your Latest Passport
(In block letters) size photograph duly
4. Father’s Name -____________________________________________ attested by Head of
Department
5. Nationality - ___________________________________________
6. Department /Programme - ___________________________________________
7. Enrollment No. - ___________________________________________
8. Date of Birth - _____________________________Age______________
9. Address - ________________________________________________________
Tel No. ____________Father/Mother Mobile No________________Mobile No. ___________________
10. Permanent Home Address -
_____________________________________________________________________________________
_____________________________________Mobile No._______________________________________
11. Vegetarian/Non-Vegetarian -
12. Details of Previous Trip/camps/courses scouting/guiding attended:
S.no Name of Camp/Course Dates Place
a)
13. Any special qualification/training/hobbies/experience relating to the concerned
Camp/Course/Activity/Water sports/swimming etc.
a) __________________________________ b) ___________________________________
14. Hobbies (Singing, dancing, Theater, fine arts, Literacy, sports etc):
a) __________________________________ b) ___________________________________
15. Medical Fitness Certificate, Affidavit, copy of I D Card is enclosed:
Yes: _________________________ No: __________________________
Signature Applicant
*As per UGC / AICTE / GGSIP University norms.
Student Declaration
I, the below mentioned name in the list for the participation in above mentioned event, do hereby solemnly affirm
and undertake as under:-
a. That, I am voluntarily participating in the event and selected; I shall strictly abide /adhere by the Rules and
Regulations of the Industrial Visits/ Educational Cum Industrial Tours/ College Trip/Sports
Tournaments/NSS Camps/ Outreach Extension Activities/ Interinstitutional Events/ Outside Academic Field
Activities venue and shall maintain peace, tranquility, discipline, and decorum at the venue failing which, I
will be liable for expulsion.
b. That, I am medically fit to undertake the above visit. I shall be wholly responsible for any Dispute or Police
case, if happened at the venue due to my carelessness, misbehavior, misconduct, and mistake due to my
carelessness/ irresponsible activity at camp site. Also, will not engage in any activities that involve alcohol,
abusive language, violence, disobedience of professors or other staff. Furthermore, I also pledge to refrain
from meeting with any unofficial students who are not permitted by college on this trip.
a. That, I shall be responsible for my own belongings, and not breach the safety & security cordon at venue
and I shall not be involved in inflicting damage to any person or type of assets/property/infrastructure at
the venue.
c. That, I have taken permission from my parents/guardian for Industrial Visits /Trip/ Educational Cum
Industrial Tours at my own Risk & Cost. In case, of illness/ accident/ mishap/ injury of any kind affecting me,
I shall not claim any compensation from organizer and/or the Institute and/or its staffs wholly or partially
responsible for any dispute and/or eventuality at the venue.
d. I hereby solemnly declare that the above particulars are correct to the best of my knowledge and belief and
nothing therein has been suppressed. I am fully aware that in case I fail to abide by the above guidelines,
college reserves the right to take any disciplinary action deemed necessary, including the possibility of
striking off my name from the college’s roster.
Dated:
Place: New Delhi Signature of the Student
Risk Certificate
It is certified that I agree to detail my son/daughter Mr./Ms. ________________________________For the
Camp/Course/training/activity for which he/she has applied, in case of any illness/mishap/injury/accident of any
kind affecting my son/daughter, I will not claim any compensation and will not hold the Host Institute/Students
Welfare Department of Management Education & Research Institute, Delhi or its staff wholly or partially responsible
for the same.
Dated: Mobile Nos. Father:________________________
Place: Delhi Mother:________________________ Signature of the
Father/Guardian
Recommendation of the CC, PC/Head of the Department
I hereby certify that the applicant Mr. /Ms. / _______________________ of programme: ___________________
Enrollment No. ___________________ of my department is recommended as being the most suitable student for
above activity. The student has to join Industrial/Corporate Visit activity at his/her own risk and that no
compensation will be payable in case of any illness/mishap/injury/accident of any kind. Also, student has not
declared any special care required/ Allergic to environment change, Asthma & High Altitudes.
Dated:
Place: Delhi Signature of Class Coordinator Signature of CC & PC/HoD
With office seal
