ipu br parte180314

ADMISSION BROCHURE 2014-15

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PART - E

S.No. Content Page No. 1 IMPORTANT INFORMATION ........................................................................................................... 2 2 Appendix 1 : GUIDELINES FOR FILLING UP APPLICATION FORM FOR CET-2014 ............ 3

3 Appendix 2 : INSTRUCTIONS FOR COMMON ENTRANCE TEST - 2014............................... 5

4 Appendix 3 : SPECIMEN COPY OF OMR ANSWER SHEET ................................................... 7

5 Appendix 4(A) : ADMISSION VERIFICATION FORM .................................................................. 9

6 Appendix 4(B) : ADMISSION VERIFICATION FORM FOR MBBS & BDS ................................... 10

7 Appendix 4(C): ADMISSION VERIFICATION FORM FOR SSMC & PGMC ................................ 11

8 Appendix 5 : FORMAT OF AFFIDAVIT FOR PROVISIONAL ADMISSION ............................. 13

9 Appendix 6 : MEDICAL CERTIFICATE .................................................................................... 14

10 Appendix 7 : PREFERENCE SHEET ....................................................................................... 15

11 Appendix 8 : FORM FOR WITHDRAWAL OF ADMISSION .................................................... 16

12 Appendix 9 : FORM FOR REFUND OF EXCESS FEE ........................................................ 17

13 Appendix 10 : UNDERTAKING FOR DEFENCE CATEGORY..................................................... 18

14 Appendix 11 : CERTIFICATE FOR AVAILING ADMISSION AGAINST PHYSICALLY HANDICAPPED QUOTA ......................................................................................19

15 Appendix 12 : CERTIFICATE FOR AVAILING ADMISSION AGAINST KASHMIRI MIGRANT QUOTA .............................................................................................. 20

16 Appendix 13 : CERTIFICATE OF SIKH MINORITY COMMUNITY.............................................. 21

17 Appendix 14 (A): ENCLOSURE FOR M. TECH PROGRAMME..................................................... 22

18 Appendix 14 (B): ENCLOSURE FOR WEEKEND PROGRAMME.................................................. 24

19 Appendix 14 (C): ENCLOSURE FOR PG DIPLOMA PROGRAMME............................................. 26

20 Appendix 15 (A): CERTIFICATE 1: FOR ADMISSION TO ACMS ................................................. 28

21 Appendix 15 (B): CERTIFICATE 2: FOR ADMISSION TO ACMS ................................................. 29

22 Appendix 15 (C): CERTIFICATE 3: FOR ADMISSION TO ACMS ................................................... 30

23 Appendix 15(D): CERTIFICATE 4: FOR ADMISSION TO ACMS ................................................. 31

24 Appendix 16 : DECLARATION BY THE CANDIDATES/ EMPLOYERS CERTIFICATES (PGMC / SSMC).................................................................................................. 32

25 Appendix 17 : SURETY BOND (PGMC /SSMC)........................................................................ 33


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(i) Students and their parents are advised, in their own interest, to visit the various Colleges/Institutes prior to the date of counselling to ascertain the location, other academic and infrastructural facilities available such as hostel, transportation etc. in the various colleges/institutes which may facilitate their decision-making at the time of counselling/admission. On the day of admission/counselling, the students will be required to take on the spot decision and no further time will be given to them.

(ii) It may be noted that (Part - F) contains the details of infrastructure and other facilities as made available to the University by the respective Colleges/Institutes. As such the institutions themselves are responsible for the authenticity of the information contained in this Appendix. The students/guardians are advised to confirm the veracity of the information contained in it about the different Institutes.

(iii) If it is found at any stage during the entire period of the programme that the candidate has furnished any false or incorrect information in the application form or at the time of counselling/admission, his/her candidature for the programme will be cancelled summarily. In addition, disciplinary action may be taken against him/her as per the University rules.

(iv) If the University is not satisfied with the character, past behaviour or antecedents of a candidate, it can refuse to admit him/her to any course of study of the University.

(v) The Vice Chancellor may cancel the admission of any student for specific reasons and debar him/her for a certain period.

(vi) Only qualifying the Common Entrance Test shall not, ipso facto, entitle a candidate to get admission to a programme.

(vii) It will also be the sole responsibility of the candidates themselves to make sure that they are eligible and fulfill all the conditions prescribed for admission. Before filling-up the verification slip at the time of counselling/allotment of seats, candidate should ensure that he/she fulfills all eligibility conditions as laid down in this Admission Brochure. If it is

found at any stage during the entire period of the programme that the candidate does not fulfill the requisite eligibility conditions, his/her admission will be cancelled and also disciplinary action will be initiated against him/her and entire fee will also be forfeited.

(viii) The merit of the CET will be valid only for the programme for which the candidate has appeared and cannot be utilized for admission to any other programme. Further, the merit of the CET- 2014 shall be valid only for the academic session 2014-15.

(ix) RAGGING : Rules in terms of ordinance relating to maintenance of discipline amongst students of the University are as under :

Ragging in any form shall be strictly prohibited within the premises of the University, a college or an Institute, as the case may be, or in any part of the University system as well as on public transport, or at any other place, public or private.

Any individual or collective act or practice of ragging shall constitute an act of gross indiscipline and shall be dealt with under the provisions of ordinance under reference.

Ragging, for the purposes of ordinance under reference, shall ordinarily mean any act, conduct or practice by which the dominant power or status of senior students is brought to bear upon the students who are in any way considered junior or inferior by the former and includes individual or collective acts or practices which:

(a) Involve physical assault or threat to use physical force.

(b) Violate the status, dignity and honour of students, in particular female students and those belonging to a schedule caste or a schedule tribe.

(c) Expose students to ridicule or contempt or commit an act which may lower their self esteem; and

(d) Entail verbal abuse, mental or physical torture, aggression, corporal punishment, harassment, trauma, indecent gesture and obscene behaviour.

IMPORTANT INFORMATION18


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Appendix 1GUIDELINES FOR FILLING UP THE APPLICATION FORM FOR CET- 2014

(i) The candidates are advised to go through the Admission Brochure carefully and acquaint themselves with all requirements in respect to filling up of the Online Application Forms for CET -2014.

(ii) It will be the sole responsibility of the candidate to make sure that he/she is eligible and fulfills all the conditions prescribed for admission.

(iii) If ineligibility of a candidate is detected at any stage before or after examination/declaration of result or during any stage of the programme, his/her candidature/admission will be cancelled without any notice, disciplinary action will be taken against him/her and entire fee will also be forfeited. The Vice Chancellor, Guru Gobind Singh Indraprastha University may cancel the admission of any student for specific reasons at any stage.

(iv) Incomplete application form will be summarily rejected and no request will be entertained in this regard.

(v) CET Code: If the candidate is desirous of appearing in more than one Test, separate Application Form should be submitted for each test. Verify the CET Code from the List of Programmes in Admission Brochure Part B before submitting the form. Any request/application for change of CET Code will NOT be entertained.

(vi) Name of the Candidate: Candidates should write his/her Name in CAPITAL LETTERS as given in Class X or equivalent certificate. If your name has several initials, leave one blank after each of them.

(vii) Name of Father/Mother: Write the name of your Father or Mother exactly as in your Class X or equivalent certificate. Writing mother's name is compulsory.

(viii) Date of Birth: Enter the date, month and year of your birth as per English calendar and as recorded in your School/Board (Class-X)/Pre-University examination certificate. Birth field is mandatory. If date of birth is not filled, the date of birth value of 01.01.1950 will be used.

(ix) Category: Select the appropriate option for your categories - SC, ST, OBC, Physically Handicapped, Defence and J&K Migrant. Categories once declared by the candidate, will be used for preparing the merit list. If no category is specified, you would be considered as falling under General'

category. And, no claim whatsoever shall be entertained thereafter. Category certificate to be verified during admission/counselling. If a candidate falls in more than two categories, he/she can select multiple options. If a general category candidate fills up a reserved category, then the candidature for admission to be considered if and only if the rank is within the general cut off rank.

(x) Gender: Select option for 'Male' or 'Female'.

(xi) Region: Select the option titled "Delhi Region" if you have passed your qualifying examination from any school/college located in Delhi or from any institution affiliated to GGSIP University. Select the option titled "Outside Delhi" if you have passed your qualifying examination from any school/college located in any other part of the country (India) excluding the institutions affiliated to GGSIP University. The correct region to be verified during admission/counselling and any correction if required to be carried out.

(xii) Qualifying Exam: Select the option titled PASSED if you have already passed the 10+2 or any other specified qualifying examination, which makes you eligible for the Entrance Test. Select the option titled "APPEARING" if you are appearing for the examination, which makes you eligible. The title "APPEARING" covers the cases of "APPEARED" candidates also.

(xiii) Religion: Select the appropriate option.(xiv) Nationality: If your nationality is Indian, option

indicated for "INDIAN". If your nationality is not Indian; option indicated for "OTHERS".

(xv) Mailing Address: Write your name and complete mailing address IN CAPITAL LETTERS including the PIN CODE along with Telephone/Mobile numbers with relevant STD Code at which the communication is to be sent.

(xvi) Photograph of the Candidate: The candidate should upload his/her recent colour photograph with white background of size as specifiedYour face should cover about 75% of the photo (without attestation) taken on or after 1st January 2014. The candidate should also upload his/her signature.

Instructions for photograph: Photograph should not have cap, goggles


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etc. (Spectacles are allowed). The face of the candidate should cover about 75% of the photo.

The candidate should keep two identical photographs with him/her, in reserve which may have to be used for pasting in the Admit Card at the time of Entrance Test /Counselling/Admission, in case of doubt regarding the identity.

(xvii) Visible Mark of Identification: Candidate should mention visible mark of identification.

(xviii) Centre of Common Entrance Test- 2014

Refer to the list of Centres of Common Entrance Test- 2014 for the Academic Programmes and CET Codes mentioned in this Admission Brochure. A centre will be invoked only if sufficient number of candidates are available.

Examination Centre once allotted by the University will not be changed and no request in this regard will be entertained under any circumstances. In case the the first and second option for centre are not invoked then the

candidate will be allocated Delhi Centre.

(xix) Verification and Counter signatures: While filling up of the application form, the candidate must verify the correctness of all the particulars furnished by him/her. In case any candidate is found to have furnished false information or is found to have concealed any material information in his/her application, he/she will be debarred from admission. Further, such a candidate shall also be liable for punishment.

(xx) The candidate will be solely responsible for all the consequences arising out of any error or omission in the Application Form.

(xxi) No request for change/correction/modification in the particulars of Application Form will be entertained.

(xxii) Candidates for MBBS Programme falling under army quota are also eligible for admission to other colleges of Medical Science and must fill up the appropriate option in the application form.


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Appendix 2

INSTRUCTIONS FOR THE COMMON ENTRANCE TEST 2014i) The Common Entrance Test shall be based on

the the topics as specified in the CET syllabus section.

ii) The candidates are required to report their Examination Centre at least half an hour before the

the CET along with their Admit Card issued by the University. No candidate will be allowed to enter the CET Centre after the scheduled commencement of exam.

iii) The Each candidate will be given a sealed Test Booklet and OMR answer sheet five minutes before the commencement of the test.

For PGMC: Each candidate will be given a sealed test booklet (Section A) and OMR answer sheet just five minutes before the commencement of the test and test booklet (Section B) just five minutes before the completion of one hour of the Test.

For SSMC: The CET will be of one and a half hours duration comprising of 100 MCQs.

iv) The OMR answer sheet is of special type which will be scanned by an optical scanner.

(v) Immediately on receipt of the Test Booklet, each candidate shall fill in the required particulars on the cover page of the Test Booklet with a black ballpoint pen only. He/she shall not open the seal of the Test Booklet until asked to do so by the invigilator.

(vi) Candidates will then write the required particulars on OMR answer sheet with a black ballpoint pen. After this, they will wait for the signal by the invigilator to start marking the responses.

(vii) The Test will start exactly at the time mentioned on the Admit Card and an announcement to start will be made by the invigilator.

(viii) While the test is in progress, the invigilator will check the Admit Cards of the candidates to satisfy himself/herself about the identity of each candidate. The invigilator will also put his/her signature in the space provided for the purpose on the OMR answer sheet as well as on the Admit Card.

(ix) The candidate will have to sign the Attendance Sheet against his/her CET Roll Number.

(x) A signal will be given at the beginning of the Test. A signal will also be given at the closing time when the candidates must stop marking the responses.

(xi) After completing the Test and before handing over the Test Booklet and the OMR answer sheet to the invigilator, the candidates are advised to make sure that all the particulars required in the Test Booklet and the OMR answer sheet have been correctly written, i.e. CET Roll Number, Name of the Candidate, CET Code, Centre Code, Test Booklet Number, Test Booklet Code, CET name.

(xii) No candidate will move out of the examination hall until the time prescribed for the Test is over.

(xiii) No candidate will take away the Test Booklet and/or the OMR answer sheet from the examination hall.

(xiv) A candidate must bring his/her own black ball point pen to fill the answers in ovals of OMR answer sheet. In case the ovals are filled by any instrument other than the black ball point pen, then the answer sheet may be rejected by the optical scanner when the same is being scanned. In all such cases, the responsibility shall rest on the candidates.

(xv) The candidate must ensure that the answer sheet is not folded. Also, he/she should not make any marks or write any kind of description on it.

(xvi) Candidates are advised to be sure about the correct answer before they darken the oval with black ball point pen. They should also ensure that the each oval is completely darkened with black ball point pen, partially or faintly darkened ovals may be rejected by the optical scanner. It may also be negatively marked.

(xvii) For all programmes excepting SSMC/MBBS/ BDS: Each question carries four marks. For each incorrect response, one mark will be deducted from the total number of marks obtained by the candidate. No deduction from the total marks will, however, be made if no response to a question is indicated. Candidates are advised not to attempt a question if they are not sure of the correct answer. If a candidate darkens more than one oval against a question, it will be deemed to be an incorrect answer and will be negatively marked.

(xviii) The Test Booklet Code filled in by the candidate


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in the OMR answer-sheet will be accepted as final for the purpose of evaluation. When the space for the Booklet Code is left blank or more than one booklet code is indicated therein, it will be deemed to be an incorrect booklet code and the answer sheet will not be evaluated. The candidate himself/herself will be solely responsible for all the consequences arising out of any error or omission in writing the Test Booklet Code.'

(xix) No candidate should do any rough work on the OMR answer-sheet. Rough work, if any, is to be done only in the Test Booklet at the space provided.

For MBBS/BDS: Each question will carry three marks. One mark will be deducted for each incorrect response.

For SSMC: There will be no negative marking.

(xx) Candidates should check to make sure that the Test Booklet contains the number of pages as mentioned on the top of the first page. In case the numbers do not tally, it should be immediately brought to the notice of the invigilator. The candidates shall not remove any page(s) from the Test Booklet and if any page(s) is (are) found missing from a candidate's booklet, he/she shall be liable for prosecution under relevant provisions of Indian Penal Code.

(xxi) In case of any confusion, invigilator may be contacted.

(xxii) No candidate, without the specific permission of the Centre Superintendent or the invigilator concerned, shall leave his/her seat in the examination hall until he/she has finished his/her paper and handed over the Test Booklet and the OMR answer-sheet to the invigilator on duty.

(xxiii) Smoking in the examination hall during the hours of the Test is strictly prohibited.

(xxiv) Tea, coffee, cold drinks or snacks are not allowed inside the examination hall during the Test.

(xxv) Candidates shall maintain perfect silence and attend to their papers only. Any conversation, gesticulation or causing disturbance in the examination will be deemed to be an act of misbehaviour and is, therefore, strictly prohibited. Also, if a candidate is found impersonating or using unfair means, his/her candidature will be cancelled and he/she will be liable to be debarred from taking the entrance tests either permanently or for a specified period depending upon the nature of the offence, in addition to any other action which may be taken under the Indian Penal Code.

(xxvi) If any candidate is found using any unfair means at any stage of admission process or does not observe discipline during the conduct of the Entrance Test, his/her candidature is liable to be cancelled.


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Appendix 3 SPECIMEN COPY OF OMR ANSWER SHEET


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Appendix 4(A) Guru Gobind Singh Indraprastha University Sec 16 C, Dwarka, New Delhi-110078 ADMISSION VERIFICATION FORM (2014-15) ( FOR ENGINEERING, B. ARCH & PROFESSIONAL PROGRAMMES)

Name of the Programme: __________________________ CET/Programme Code_________________________________________________

Name of Candidate : (Mr/Miss/Mrs) ______________________________________________________________________________________

Address: _____________________________________________________________________________________________________________

_________________________________________________________PIN Code___________________________________________________

Tele. No. (with STD code) _____________________ Mobile No. ______________________ Email Id: _______________________________

Minority Community (If applicable) _________________________________________________________________________ (Sikh/Muslim)

CET Roll No. ____________________________Category (SC/ST/OBC/Def/PH/Kashmiri Migrant)_____________________________________

CET Rank ___________________________1. School / College location (of qualifying examination)____________________________________ (Delhi / Outside Delhi) 2. Date of Birth _________________________ Age as on 1-8-2014: years_______________months ____________ days ___________ (As per Secondary School Certificate)

3. Passed Senior Secondary Examination / Three year Diploma in Engg. ______________________________________ : Yes/No

4. Aggregate percentage of all subjects in Sr. Secondary Examination/Dip. in Engg ______________________________ : %

5. Passed in English in 12th Class _____________________________________________________________________ : Yes/No

6. PCM/PCB Percentage in 12th Class _________________________________________________________________ : %

7. Best four subjects including one language (Percentage in 12th Class) _______________________________________ : %

8. Passed in Maths / Computer Science / Computer Applications in 12th Class __________________________________ : Yes / No

9. Category Certificate SC / ST / OBC / PH / Defence / Kashmiri Migrants / Minority Community (Attach photocopy) : Yes / No 10. Character Certificate (Attach photocopy) _____________________________________________________________ : Yes / No

11. Medical Certificate (Attach Original) _________________________________________________________________ : Yes / No

12. Passed Graduation in the year ________________Percentage of marks in graduation _________________________ : %

13. Passed Post-Graduation in the year____________ Percentage of marks in post-graduation _____________________ : %

14. (a) NATA/GATE Score ___________________

(b) Year of Passing ____________________

15. Details of Demand Draft(s) for Submission of fees

Amt:________________ DD No.____________________ Bank/Branch__________________________________



I solemnly affirm that the information furnished above is true and correct in all respects. I have not concealed any information. I realize that if any information furnished herein is found to be incorrect or untrue, I shall be liable to criminal prosecution and also forgo my claim to the seat in the college. Further, that my candidature for examination/selection and admission to the course is liable to be cancelled. I agree to abide by the rules & regulations of the University.

Signature of the Parent/Guardian & Date Signature of Candidate & Date

FOR OFFICE USE ONLYCertificates Checked and Verified by University official

Certificates Checked & Verified by : University : Guru Gobind Singh Indraprastha University

Name of the Admission Assistant : ____________________________ Name of the Institute admitted to :__________________________

Signature of the Admission Assistant : __________________________ Name of the Admission Officer : ____________________________

Date : ______________ Signature of the Admission Officer : _________________________

University Enrolment No.__________________________________

Note : Use Photocopy of this form

Self attested photograph


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Appendix- 4(B)

Name of the Programme :________________________________________________________

Name of Candidate (Mr/Miss/Mrs) :_________________________________________________

Address: __________________________________________________________________________________

Tel. No. ________________Mob No. _______________E-Mail Address: ______________________________

CET Roll No. ________________ CET Rank: __________________ Category: _________________________ SC/ST/OBC/PH

1. School / College location (of qualifying examination) _______________________ Delhi/Outside Delhi

2. School / College location (of qualifying 11th class) _______________________ Delhi/Outside Delhi

3. Date of Birth __________________Age as on 31-12-2014 : years __________months __________ days _________ (As per Secondary School Certificate)

4. Passed Senior Secondary Examination _______________________________________ : Yes / No

5. Aggregate percentage of all subjects in Sr. Secondary Examination__________________ : %

6. Passed in English in 12th Class______________________________________________ : Yes / No

7. P.C.B. Percentage in 12th Class_____________________________________________ : %

8. Category Certificate SC / ST / OBC / PH/DEF (if applicable)________________________ : Yes / No

9. Character Certificate_______________________________________________________ : Yes / No

10. Medical Certificate (in case of PH category)_____________________________________ : Yes / No

11. Details of Demand Draft/s for Submission of fees

Amt:_____________________DDNo.___________________Bank/Branch____________________________ Amt:_____________________DDNo.___________________Bank/Branch____________________________

I have carefully read and verified the information furnished by my son/daughter/ward and affirm that it is true and correct and he/she fulfills the eligibility conditions as mentioned in the Admission Brochure.

Signature of the Parent/Guardian & Date Signature of the Candidate & Date__________________________________________________________________________________________


Certificates Checked & Verified by : _________________ University : Guru Gobind Singh Indraprastha University

Name of the Admission Assistant : __________________ Name of the Institute admitted to : ________________ Signature of the Admission Assistant : _______________ Name of the Admission Officer : _____________________

Date: ________________________ Signature of the Admission Officer : ___________________



Guru Gobind Singh Indraprastha UniversitySector-16 C, Dwarka, New Delhi - 110078

ADMISSION VERIFICATION FORM (2014-15) (FOR MBBS & BDS PROGRAMMES)


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Appendix-4(C)

Guru Gobind Singh Indraprastha UniversitySector-16 C, Dwarka, New Delhi - 110078

ADMISSION VERIFICATION FORM (2014-15) (FOR PGMC/ SSMC PROGRAMMES)

A. Details of the Candidate with following particulars

Name _______________________________________ Father's Name: ______________________________________

CET Roll No._____________________________________CET RANK _________________________________________

Date of Birth _______________________ Category_________________________ Gender:_________________________

Address (with PIN Code)______________________________________________________________________________

Tel/Mob No. _____________________________ Email Address: ______________________________________________

Name of Last Qualified Degree ___________________________

B. Documents to be submitted at the time of Counselling/verification for Academic session 2014-15i) High School/Higher Secondary Certificate for verification of date of birth (Both Original & Photocopy) ii) Certificate in support of educational qualification: MBBS Degree (Both Original & Photocopy) iii) Detailed marks certificate of qualifying examinations: I, II & Final Professional examination of MBBS (Both Original & Photocopy)iv) The compulsory rotating internship certificate (Both Original & Photocopy)v) Registration Certificate from Delhi Medical Council/ State Medical Council/ Medical Council of India (Both Original & Photocopy)vi) MD/MS/DNB Examination attempt certificate (in case of SSMC only) (Both Original & Photocopy)vii) Proof of writing thesis in case of candidate has DNB course (in case of SSMC only) (Both Original & Photocopy)viii) Original Caste Certificate (in case of PGMC only, if applicable) (Both Original & Photocopy)ix) Character Certificate from where the qualifying examination was passed (Both Original & Photocopy)x) Physically Challenged Certificate (in case of PGMC only, if applicable) (Both Original & Photocopy)xi) Employers Certificate and a No Objection Certificate (NOC), if employed (in the prescribed format as per given Appendix in Part - E xii) Admit Card in Original (Both Original & Photocopy)xiii) Bank Draft of Amount Rs. 27,500/- xiv) Bond of Rs.3 Lacs (for PGMC) & Rs.2 Lacs (for SSMC) on a non-judicial stamp paper of Rs.100/- filled and signed by two sureties (other than relatives) in the prescribed format as per Appendix 17 (Both Original & Photocopy)xv) Declaration by the Candidate as per Appendix 16.

I solemnly affirm that the information furnished above is true and correct in all respects. I have not concealed any information. I realize that if any information furnished herein is found to be incorrect or untrue, I shall be liable to criminal prosecution and also forgo my claim to the seat in the college. Further, that my candidature for examination/selection and admission to the course is liable to be cancelled. I agree to abide by the rules & regulations of the University.

Date:__________________________ Signature of Candidate



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Certificates Checked & Verified by : _________________ University : Guru Gobind Singh Indraprastha University

Name of the Admission Assistant : __________________ Name of the Institute admitted to : ________________ Signature of the Admission Assistant : _______________ Name of the Admission Officer : _____________________

Date: ________________________ Signature of the Admission Officer : ___________________



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Appendix 5

Format for Affidavit(To be Submitted at the Time of Counselling/Admission by

Candidates Seeking Provisional Admissions) (on Non-Judicial Stamp Paper of Rs. 10/- duly attested by Notary Public)

I/My ward _________________________________________ (Name of the candidate), Son/Daughter/ Wife of ______________________________________________________________(Father's/Husband's name) Resident of _______________________________________________________________(Permanent address) seeking admission to ____________________________________ (Name of the Course) of GGSIP University, hereby solemnly affirm and declare

(i) that I/My ward have/has appeared in the 12th class/final semester/finalyear (name of the qualifying degree) e.g. B.A., B.Sc. etc.) ___________________ Examination, 2014 of ____________________ (Board/University), the result of which has not yet been declared and is expected to be declared latest by 30 September, 2014;

(ii) I have passed all the papers of the qualifying degree ___________________ (name of the qualifying degree) examination other than the final year/final semester examination

(iii) I have no compartment as on this date in my 12th class /qualifying degree examination.

(iv) I am seeking provisional admission due to non-declaration of result of final year/final semester of the qualifying degree examination by Board/University and not on account of compartment in current or previous years of the qualifying degree examination as on date of admission.

(v) That I/My ward have/has carefully gone through the rules regarding provisional admission and fully understand that in the event of my/my ward's failure to submit to the concerned Dean/Principal/Director of the concerned School/College where the admission has been granted, appropriate proof of my/my ward securing at least _________________ marks in qualifying examination for admission to ________________________(Name of the Course) of GGSIP University by 30 September, 2014; my/ my wards provisional admission to the said course will automatically get cancelled and full fee deposited will be forfeited.

Deponent

Verification :

Verified at __________________________on this _________________day of _________________, 2014

that the contents of the above Affidavit are true and correct to the best of my knowledge and belief. No part

of it is false and nothing material has been concealed therefrom.

Deponent

Notes: (i) In case the candidate is minor i.e. below 18 years of age; in that case, the affidavit shall be signed by

his/her parent/guardian.

(ii) Submission of false affidavit is punishable offence. If it is found at any stage that false affidavit was submitted, admission shall be cancelled and legal proceedings shall be initiated, for which candidate/parent/guardian shall be responsible.


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Appendix 6

I certify that I have carefully examined Shri/Km/Smt.*_______________________________________ son/

daughter/wife of Shri/Smt.* __________________________________________________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.

Visible Mark of Identification _____________________________________________

Signature of the Candidate__________________________________________

Place :

Date :

Name & Signature of the Medical Officer with Seal and Registration Number

* Strike whichever is not applicable.

** To be signed by a Registered Medical Practitioner holding a Medical degree.

Note : Use photocopy of this Form

MEDICAL CERTIFICATE**(TO BE SUBMITTED AT THE TIME OF COUNSELLING/ADMISSION)


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Appendix 7

Guru Gobind Singh Indraprastha UniversitySector 16 C, Dwarka, New Delhi - 110 078

PREFERENCE SHEET

Name of the Programme: _______________________________________________________________

Name: Mr/Miss/Mrs. ___________________________________________________________________

Address: ___________________________________________________________________________

______________________________________________________ PIN: _______________________

Telephone No(with STD Code): __________________________ Mob: ___________________________

E-mail Adress: __________________________________________________________________________

CET Roll No. CET Rank Region: Delhi/Outside Delhi Category: Gen/SC/ST/OBC/Def/PH/KM

________ ________ ___________________ _________________________

Give preference in order of your Priority :S.No. Name of the College/Institute Programme/Branch

1. ................................................................................ .........................................

2. ................................................................................ .........................................

3. ................................................................................ .........................................

4. ................................................................................ .........................................

5. ................................................................................ .........................................

6. ................................................................................ .........................................

7. ................................................................................ .........................................

8. ................................................................................ .........................................

9. ................................................................................ .........................................

10. ................................................................................ .........................................

11. ................................................................................ .........................................

12. ................................................................................ .........................................

13. ................................................................................ .........................................

14. ................................................................................ .........................................

___________________________________Date : ____________________ (Signature of the Candidate)

____________________________________ (Counter Signature of Parent/Guardian)Note : The preference sheet is valid only for one particular counselling not for all round

of counselling & waiting list. The Candidate will fill up separate preference sheet in separate counselling.


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Appendix 8Guru Gobind Singh Indraprastha University

Sector 16 C, Dwarka, New Delhi - 110078

FORM FOR WITHDRAWAL OF ADMISSION (Must be submitted in Admission Branch only)

1. Programme & Institute : ___________________________________________________________________ (from which withdrawing)

2. Name of Student : ___________________________________________________________________

3. Parent / Guardian's Name : ___________________________________________________________________

4. Address : ___________________________________________________________________

__________________________________PIN_______________________________

5. (a)Telephone : ___________________________________________________________________

(b) Mobile : ___________________________________________________________________

(c) Email address : ___________________________________________________________________

6. Enrollment Number : ___________________________________________________________________

7. CET Roll Number : ___________________________________________________________________

8. (a) Name & Relationship of the : ___________________________________________________________________ concerned in favour of whom bank transfer is to be made

(b) Bank detail of above concerned to be furnished in the given format :

Name of the Bank Address of the Bank

Complete Bank Account No.

IFSC CODE OF THE BANK BRANCH

U N D E R T A K I N G

We understand and know the refund rules of the University & agree to abide by the same and we further understand that the refund would be made in due course of time through bank transfer only as per above request.

_______________________________ ___________________________

(Signature of Parent / Guardian) (Signature of Student)

Date:______________ Date:______________

Compulsory Encl. : 1. Both copies of Fee Receipt issued at the time of Admission / Counselling in ORIGINAL

2. Cancelled cheque of CBS Bank branch, showing the detail of full bank A/c No.; IFSC code; beneficiary name etc. must be attached by the concerned student along with the Withdrawal Form

Refund amount will directly be transferred in the bank account submitted by the student through electronic mode (ECS/RTGS/NEFT). Therefore, student may ensure to provide correct details under S. no. 8 (a) & (b) & the required enclosures. University

will not be liable for any wrong transfer of amount on account of incorrect bank information provided by the student.



PART - E


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1717


Sector 16 C, Dwarka, New Delhi - 110078FORM FOR REFUND OF EXCESS FEE

(Paid at the time of Admission/Counselling) (Must be submitted in Admission Branch only)

1. Programme & Institute : ___________________________________________________________________

2. Name of Student : ___________________________________________________________________

3. Parent / Guardian's Name : ___________________________________________________________________

4. Address : ___________________________________________________________________

__________________________________PIN_______________________________

5. (a)Telephone : ___________________________________________________________________

(b) Mobile : ___________________________________________________________________

(c) Email address : ___________________________________________________________________

6. Enrollment Number : ___________________________________________________________________

7. Amount of Fees Deposited at the : ___________________________________________________________________ time of counselling

8. CET Roll Number : ___________________________________________________________________

9. (a) Name & Relationship of the : ___________________________________________________________________ concerned in favour of whom bank transfer is to be made

(b) Bank detail of above concerned to be furnished in the given format :

Name of the Bank

Address of the Bank

Complete Bank Account No.

IFSC CODE OF THE BANK BRANCH

U N D E R T A K I N G

We understand and know the refund rules of the University & agree to abide by the same and we further understand that the refund would be made in due course of time through bank transfer only as per above request.

_______________________________ ________________________________________ (Signature of Parent / Guardian) (Signature of Student)

Date: ______________ Date: ______________Compulsory Encl. : 1. A copy of Fee Receipt issued at the time of Admission / Counselling

2. Cancelled cheque of CBS Bank branch, showing the detail of full bank A/c No.; IFSC code; beneficiary name etc. must be attached by the concerned student along with the Form for Refund of Excess Fee.

Refund amount will directly be transferred in the bank account submitted by the student through electronic mode (ECS/RTGS/NEFT). Therefore, student may ensure to provide correct details under S. no. 9 (a) & (b) & the required enclosures. University

will not be liable for any wrong transfer of amount on account of incorrect bank information provided by the student.



PART - E

18


Sector 16 C, Dwarka, New Delhi - 110078

UNDERTAKING FOR DEFENCE CATEGORY

I _______________________________Son /Daughter of______________________________________

CET Roll No.____________CET Rank_____________________ Programme________________________

hereby undertake that I fall under the following Priority of Defence category as tick marked below:-

(i) Widows/Wards of Defence personnel killed in action.

(ii) Wards of serving personnel and ex-servicemen disabled in action. (iii) Widows/wards of Defence personnel who died in peace-time with death attributable to

military service; (iv) Wards of Defence Personnel physically disabled in peace-time with physical disability with

not less than 40% attributable to military service. Physical disability must be suffered during the service at the time of undergoing military training/ military action in peace time. (Low medical categories due to medical diseases which may be due to aggravation or may be attributable to military service will not be considered);

(v) Wards of ex-servicemen and serving personnel who are in receipt of Gallantry Award; (vi) Wards of serving and ex-servicemen in order of merit.

Name of Father/Mother____________________ Name: ________________________________

Rank___________________________________ Address: ______________________________

Service No. _____________________________ ______________________________________

Unit ___________________________________ Tel /Mob No: ____________________________

Signature of Father/Mother _________________ Signature of Candidate: _____________________

Countersigned by : Secretary, Kendriya Sainik Board, New Delhi / Secretary, Rajya or Zila Sainik Board / Officer-in-Charge, Record Office / Ist Class Stipendiary Magistrate/CO Unit / Formation Commander

I have checked the original documents and I certify that he/she is entitled for reservation under defence category under priority__________________(which ever applicable).

Date :

Place : Seal Signature of the officer

Photograph duly attested by

the officer who has certified

this certificate


PART - E


PART - E

1919

Appendix 11

Certified that Shri/ Km/ Smt. _______________________________________________________

son/daughter/wife of Shri/Smt. ______________________________________________ is physically

handicapped due to ___________________________________________________________ and he/

she is fit for undergoing the course(s) ____________________________________________________at

Guru Gobind Singh Indraprastha University, Delhi.

Name & Signature ofThe Officer In-charge

Vocational Rehabilitation CentreFor Physically Handicapped

9,10,11 Karkardooma, Vikas MargDelhi-110092.

(Office Stamp)

Date :


Photograph duly attested by

the officer who has certified

this certificate

Certificate for Availing Admission Against Physically Handicapped Quota

(To be submitted at the Time of Counselling/Admission)


PART - E

20

Appendix 12

Photograph duly attested by the officer who has certified

this certificate

Certificate for Availing Admission Against Kashmiri Migrant Quota

(To be submitted at the Time of Counselling/Admission)

Certified that Shri/Km/Smt. ________________________________________________ son/daughter/wife

of Shri/ ____________________________________________________________________________

resident of_________________________________________________ is registered as migrant from

Jammu & Kashmir.

The Registration number is ______________________ dated ____________________

It is also certified that Shri/Km/Smt __________________________________________ is registered in

Delhi as J & K Migrant on _____________________.

Name & Signature of Deputy Commissioner/

Competent Authority

(Office Stamp)

Place :

Date :


Note : No other Document other than this will be accepted by the University for claiming reservation against the Kashmiri Migrant Quota.


PART - E


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2121

Appendix 13

Ref. :............................ Date .......................

TO WHOM SO EVER IT MAY CONCERN

This is certified that ............................................................................................................(Name of Student)

S/o/D/o........................................................................................................................................................

resident of ..............................................................................................................................................

belongs to Sikh Minority Community and is entitled for seat under SIKH MINORITY QUOTA.

President/Gen Secy./Authorised Signatory

(Authorised by President DSGMC)

(Office Stamp)

SPECIMEN COPY OF SIKH MINORITY COMMUNITY


PART - E

22

M.Tech Programmes (with Qualified GATE Score)

(SESSION 2014-15)

1.Please tick mark ( ) in the appropriate programme. 2. Use separate forms for each programme.

PROGRAMME APPLIED FOR:

CET Code 139: M.Tech. [IT/CSE/IS/ CSE(W) /IT(W)] CET Code 140: M.Tech. [(ECE/DC/VLSI/RF&M/SP/ECE(W)]

CET Code 147: M.Tech. (Tool Engg)

CET Code 148: M.Tech (Food Processing Technology)

CET Code 149: M.Tech (Nano Science & Technology)

CET Code 150: M.Tech (Engineering Physics)

CET Code 166: M.Tech (Chemical Engineering)

GATE Score: ________________ GATE Subject: _______________________ GATE Year: ________

1. Name of Candidate : (Mr/Ms/Mrs) _______________________________________________________

2. Name of Father/Mother : (Mr/Ms/Mrs) ____________________________________________________

3. Address: (Same as filled in CET Form)____________________________________________________

____________________________________________PIN Code_____________________

4. Tele. No. (with STD code) ___________________ Mobile No.____________________

E.mail ________________________________________________________________________

5. Date of Birth ___________________________________________________________________

6. Nationality : Indian _____________________________ Other _______________________________

7. Sex: Male ______________________________ Female ________________________________

8. Marital Status: Married ________________________ Unmarried ___________________________

9. Region: Delhi ____________________________ Outside Delhi ______________________________For Delhi Region, if you have passed your qualifying examination from any college located in Delhi or from any institution affiliated to GGSIP University.For Outside Delhi Region if you have passed your qualifying examination from any college located in any other part of the country (India) excluding the institutions affiliated to GGSIP University.

Guru Gobind Singh Indraprastha UniversitySector 16 C, Dwarka, New Delhi - 110078

Photograph duly attested

(same as affixed in Application

Form)

Appendix 14(A)


PART - E


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2323

10. Category: General ___________ SC ____________ ST _________________ PH _________________

Defence __________Univ. Employee___________Teacher of Affiliated Institution_______________

11. Type of Sponsorship: Govt. Sponsored ________________________ Others _____________________ (Kindly attach the sponsorship certificate from the Employer separately)

Examination Degree Board/University Year Name/ Address Percentage of the Institution of Marks10th (Secondary)12th (Sr. Secondary)Qualifying Degree(Graduation or its equivalent)

Post Graduate

Other qualifications,if any

Note: Please attach attested photocopies of the marks-statement of the qualifying examination(s)

13. WORK EXPERIENCE: ............................ TOTAL EXPERIENCE: ............................ (in completed years as on 30.06.2014)

S. No. Organization Name, Designation Worked Nature of work Address & Telephone No. From To

Note: Please attach attested photocopies of the experience certificate.

14. UNDERTAKING

I hereby solemnly and sincerely affirm that I fulfill the eligibility conditions prescribed by the university and that the statements made and information furnished by me in the CET Application Form and this enclosure is same and are true and correct and have not withheld any information. If it is found at a later stage that any information furnished herein is fraudulent, incorrect or untrue in material particular, I realize that I am liable to prosecution and that the admission to the programme shall be cancelled. I agree to abide by the rules and regulations as contained in the Admission Brochure and other provisions notified by the University. I am also aware that my admission is provisional and is subject to verification of my eligibility.

Signature of Parent/Guardian Signature of the CandidateDate:______________

Note: 1. It is mandatory for all candidates seeking admission in M. Tech Programmes to submit online applications and further take the printout of the application and send it in a sealed envelope along with the enclosure to the concerned University Schools/Office within the specified period. 2. The applications of the students will not be treated as complete and further the students will not be eligible for admission if the applications do not reach the concerned Schools/Office within the specified date i.e 28th April, 2014.

12. DETAILS OF EXAMINATION PASSED :


PART - E

24

WEEKEND PROGRAMMES(SESSION 2014-15)

1. Please tick mark () in the appropriate box.

2. Use separate forms for each programme. However, one application form can be used for applying for LLM (Cyber Law and Cyber Crime) or LLM (Intellectual & Industrial Property Law).

PROGRAMME APPLIED FOR:1. University School of Management Studies (USMS) Programme Code 155: MBA : Functional Specialisations (Finance, Human Resource, International

Business, Information Technology, Marketing; Sectoral Specialisations (Consultancy, Banking, Insurance, Real Estate)

2. Centre for Disaster Management Studies (CDMS )

Programme Code 186: MBA (Disaster Management)3. University School of Mass Communication (USMC) Programme Code 176: Master of Journalism and Mass Communication (MJMC) 4. University School of Law and Legal Studies (USLLS)

Programme Code 181: LLM (Cyber Law and Cyber Crime) Programme Code 181: LLM (Intellectual & Industrial Property Law)


2. Name of Father/Mother : (Mr/Ms/Mrs) ____________________________________________________

3. Address: (Same as filled in Application Form)_________________________________________

______________________________________________________ PIN Code_________________

4. Tel. No. (with STD code) ___________________ Mobile No.____________________

E.mail ________________________________________________________________________

5. Date of Birth ___________________________________________________________________


7. Sex: Male ______________________________ Female ________________________________




Appendix 14 (B)

Photograph duly attested


Form)


PART - E


PART - E

2525


Defence __________Univ. Employee___________Teacher of Affiliated Institution_______________

11. Type of Sponsorship: Govt. Sponsored ________________________ Others _____________________ (In case of government employees applying for MBA (Disaster Management), kindly attach the

sponsorship certificate from the employer)


S.

No.

ORGANIzATION NAME,

ADDRESS, TELEPHONE NO,

DESIGNATION WORKED

From ToNATURE OF

WORK


14. Statement of Purpose (Why do you want to pursue the Weekend programme?) Write in about 100 words (Please attach separately).

15. UNDERTAKING I hereby solemnly and sincerely affirm that I fulfill the eligibility conditions prescribed by the university

and that the statements made and information furnished by me in the Application Form and this enclosure is same and are true and correct and have not withheld any information. If it is found at a later stage that any information furnished herein is fraudulent, incorrect or untrue in material particular, I realize that I am liable to prosecution and that the admission to the programme shall be cancelled. I agree to abide by the rules and regulations as contained in the Admission Brochure and other provisions notified by the University. I am also aware that my admission is provisional and is subject to verification of my eligibility.


Note: 1. It is mandatory for all candidates seeking admission in Weekend Programmes to submit online applications and further take the printout of the application and send it in a sealed envelope along with the enclosure to the concerned University Schools/Office within the specified period. 2. The applications of the students will not be treated as complete and further the students will not be eligible for admission if the applications do not reach the concerned Schools/ Office within the specified date i.e 28th April, 2014 for all weekend programmes excepting for MBA(DM) for which the last date is 16th June, 2014.

Examination Degree Board/University Year Name/ Address Percentage of the Institution of Marks

10th (Secondary)

12th (Sr. Secondary)Qualifying Degree(Graduation or itsequivalent)

Post Graduate Other qualifications,if any

Note: Please attach attested photocopies of the marks-statement of the qualifying examination(s) (Marks in CGPA /CPI or any other grade format is to be converted into percentage and the formula of conversion is to be provided)



PART - E

26

Appendix 14 (C)

PG DIPLOMA PROGRAMMES(SESSION 2014-15)

PROGRAMME APPLIED FOR (Please tick mark () in the appropriate box)University School of Basic & Applied Sciences (USBAS)

Programme Code 151: PG Diploma in Radiological Physics


2. Name of Father/Mother : (Mr/Ms/Mrs) _____________________________________________________

3. Address: (Same as filled in Application Form)__________________________________________

______________________________________________PIN Code_____________________

4. Tel. No. (with STD code) ____________ Mobile No.______________ E.mail ______________________

5. Date of Birth ____________________________________________________________________


7. Sex: Male ______________________________ Female __________________________________




Defence ______________

11. Type of Sponsorship: Govt. Sponsored ________________________ Others _____________________ Kindly attach the sponsorship certificate from the employer separately.

Photographduly attested




PART - E


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2727


S.

No.

ORGANIzATION NAME,

ADDRESS, TELEPHONE NO,

DESIGNATION WORKED

From ToNATURE OF

WORK



14. UNDERTAKING I hereby solemnly and sincerely affirm that I fulfill the eligibility conditions prescribed by the university

and that the statements made and information furnished by me in the Application Form and this enclosure is same and are true and correct and have not withheld any information. If it is found at a later stage that any information furnished herein is fraudulent, incorrect or untrue in material particular, I realize that I am liable to prosecution and that the admission to the programme shall be cancelled. I agree to abide by the rules and regulations as contained in the Admission Brochure and other provisions notified by the University. I am also aware that my admission is provisional and is subject to verification of my eligibility.


Note: 1. It is mandatory for all candidates seeking admission in Post Graduate Diploma Programmes to submit online applications and further take the printout of the application and send it in a sealed envelope along with the enclosure to the concerned University Schools/Office within the specified period. 2. The applications of the students will not be treated as complete and further the students will not be eligible for admission if the applications do not reach the concerned Schools/ Office within the specified date i.e 28th April, 2014.

Examination Degree Board/University Year Name/ Address Percentage

of the Institution of Marks

10th (Secondary)

12th (Sr. Secondary)

Qualifying Degree

(Graduation or its

equivalent)

Post Graduate

Other qualifications,

if any

Note: Please attach attested photocopies of the marks-statement of the qualifying examination(s)


PART - E

28

Appendix 15 (A) CERTIFICATE NO 1

(Refer to admission in ACMS in Part B & C of Admission Brochure)CHILDREN OF SERVING ARMY PERSONNEL HAVING 10 YEARS CONTINUOUS SERVICE IN

THE ARMY, RETIRED/RELEASED/DISCHARGED AFTER 10 YEARS OF SERVICE OR GRANTED/AWARDED REGULAR/FAMILY/LIBERALIzED FAMILY/DISABILITY PENSION

(By OC Unit/Pers Branch, AHQ/DSS & A Board/Record Office)

1. Certified that Mr/Ms _______________________is Son/Daughter of No___________ Rank ___________ Name_____________________ Unit _____________________ who has 10 years of con-tinuous service in the Army from _________________ to _______________.

2. Certified that Mr/Ms ____________________ is Son/Daughter of No ______________ Rank ___________ Name ____________________________ who has been released/discharged from Army after 10 years of service from ___________________ to __________________.

3. Certified that Mr/Ms ____________________ is Son/Daughter of No ______________ Rank ___________ Name ____________________________ who has been granted/awarded regular pension, family pension, liberalised family pension or disability pension at the time of his superannuation, demise, discharge or Release / Invalidment Medical Board.

4. Certified that Mr/Ms ______________________ is Son/Daughter of No/Ex Recruit No___________ Rank ___________ Name _________________ who was medically boarded out and granted disability pension.

Place: OC Unit/Pers Branch, AHQ (for serving personnel)Date: DSS & A Board/ Record Office (for retired personnel)Office Seal Name Designation

Name and Signature of the Candidate .Name and Signature of Parent

Notes: 1. Strike out the portion which is not applicable.

2. If retired/released with pension benefits, attach certificate from Pension paying authority.

3. If retired/released on medical grounds with disability pension, attach copy of Medical Board proceedings.

4. If released/discharged after 10 years of service, attach copy of Discharge certificate/ Release order.


PART - E


PART - E

2929

Appendix - 15(B)CERTIFICATE NO 2

(Refer to admission in ACMS in Part B & C of Admission Brochure)

STEP CHILDREN OF ARMY PERSONNEL WHO WERE BORN FROM WEDLOCK WHERE ATLEAST ONE PARENT BELONGED TO THE ARMY/ ADOPTED CHILDREN OF ARMY PERSONNEL WHO HAVE BEEN ADOPTED ATLEAST 5 YEARS PRIOR TO

COMMENCEMENT OF COURSE

By OC Unit/Pers Branch, AHQ/DSS & A Board/Record Office)

1. Certified that Mr/Ms ____________________is Son/Daughter of No ___________ Rank________________ Name_______________________________ Unit ______________ and he/she was born from wedlock where the father/mother belonged to Army and had served in the Army for 10 years or is serving in the Army and has minimum 10 years of service.

2. Certified that Mr/Ms ________________________is Son/Daughter of No _________Rank________________ Name__________________________ who had served in the Army for 10 years or is serving in the Army and has minimum 10 years of service and he/she was adopted on _____________ (5 years prior to commencement of course).

Name and Signature of Parent

OC Unit/Pers Branch, AHQ (for serving personnel)Place: DSS & A Board/ Record Office (for retired personnel)Date: NameOffice Seal Designation

Name and Signature of the Candidate..

Notes: 1. Attach copy of legal papers and Part II order of adoption of child. 2. Attach Certificate/ Part II order of birth and copy of kindred roll.


PART - E

30

Appendix 15 (C)CERTIFICATE NO 3

(Refer to admission in ACMS in Part B & C of Admission Brochure)

CHILDREN OF ARMY MEDICAL/DENTAL CORPS OFFICERSSERVING IN AIR FORCE/NAVY AND MNS/APS AND TA PERSONNEL

(By Parent & Countersignature by OC Unit/Pers Branch, AHQ/DSS & A Board/Record Office)

1. I, No ________________Rank __________Name___________________________Father/Mother of _________________________________ certify that:-(a) I am/was commissioned in Army Medical/Dental Corps and have/had not been seconded to Navy or Air Force and have 10 years of service in the Army.OR(b) I am/was commissioned in Army Medical/Dental Corps and have/had been seconded to Navy or Air Force but I have/had served in the Army for minimum 10 years.

(c) I am/was APS personnel on deputation and have/had more than 10 years of service in the Army from ____________________to __________________.OR(d) I am/was APS personnel directly recruited into APS and have/had more than 10 years of service in the Army from ____________________to __________________.

(e) I am/was TA personnel who is in receipt of pension and have/had put in more than 10 years of embodied service in TA from ____________________to____________________.

(f) I am/was member of MNS who is in receipt of pension and have/had more than 10 years of service as member of MNS.

Place: Signature Date: Name, Designation and Unit COUNTERSIGNED

The facts in the above mentioned undertaking have been verified from official records and found correct. OC Unit/Pers Branch, AHQ (for serving personnel)Place: DSS & A Board/ Record Office (for retired personnel)Date: NameOffice Seal Designation

Name and Signature of the Candidate

1. Strike out the Portion/Para not applicable.2. Relevant documents of service record.


PART - E


PART - E

3131

Appendix - 15 (D)WILLINGNESS CERTIFICATE (CERTIFICATE NO 4)

(For MBBS Programme)

1. I ..son/daughter of .. .declare that:-

(a) I fulfil all the eligibility conditions for admission to ACMS as laid down in the Admission Brochure.

(b) I have passed the qualifying examination in .(Year)

(c) I have read all the rules for admission to MBBS course and only after understanding these rules, I am submitting this declaration.

(d) The information given by me in my application is true to the best of my knowledge.

(e) I hereby agree to conform to any rule, act and law enforced by GGSIP University/ACMS and I hereby undertake that as long as I am a student of ACMS, I will do nothing either inside or outside the ACMS that will result in disciplinary action against me under the rules, act and laws of the GGSIP University/ACMS.

(f) I fully understand that the Management of ACMS will have full liberty to expel/rusticate me from the College for any infringement of the rules of conduct and discipline prescribed by the GGSIP University/ACMS and the undertaking given above.

(g) I undertake and bind myself to pay tuition fee and other charges as laid down in Admis-sion Brochure. I also undertake to pay the revised fee and other charges as revised by ACMS from time to time and in case of default on my part, the Management of the ACMS may take action as deemed fit including striking off my name from the rolls of the college.

(h) I fully understand that ragging is banned in the College and Hostel and if I indulge in such an act, I shall be subject to laid down punishment.

2. I have read and certify/accept all of the above clauses.

. . Signature of the Parent Signature of the Candidate Date: Date:

ACCEPTING AUTHORITY(For office use only)

1. Accepted/Rejected : (Mention in ink in front)

2. If rejected assign reason clearly :

Date : (Signature along with Name & Designation)


PART - E

32

DECLARATION BY THE CANDIDATE

[for Post Graduate Medical Programmes (PGMC/SSMC)]a. I ,____________________________.(name) son/daughter of Smt_______________.and

Shri_____________________________________resident of________________________ hereby, solemnly and sincerely affirm that the statement made and information furnished by me in the application form is true and correct. I have not concealed any information. If any information furnished, herein, is found fraudulent, incorrect or untrue, I understand that I am liable to criminal prosecution, and I also agree to forego my seat in SSMC / PGMC. Further I am liable to be punished by the University and the selection and admission to the course is liable to be cancelled. I agree to abide by the Rules and Regulations governing the Examination as contained in the Admission Brochure.

b. In case, I fail to join the course offered to me and accepted by me within the prescribed date, my selection/ registration to the course be treated as cancelled.

c. I undertake that in the event of my admission to any SSMC/Degree/Diploma course I will not apply for or accept admission to any course in any University/ Institution till I complete the course to which I am admitted on the basis of this application. I further undertake that in the event of my resigning the course concerned to which I am admitted, I will not appear in the next and subsequent Entrance Tests, till the duration of the course concerned is over.

d. I undertake that in the event of my selection for a SSMC / PGMC, I shall deposit all my original certificates alongwith a Surety Bond of Rs. 2 lacs in case of SSMC / Rs 3 lacs in the case of PGMC. In the event of (i) my not joining the course at the allotted institution on or before the stipulated date (ii) leaving the course before its completion and (iii) cancellation/ termination of my admission/ registration by the University on account of unsatisfactory performance / conduct/ discipline, I will deposit a sum of Rs.3 lacs / Rs. 2 lacs as applicable in the institution where I am enrolled to redeem my original certificates.

e. I agree to undergo the said course on full-time basis and shall not engage myself in practice or any part-time/full-time job during the period of the course and if I do so, my name may be removed from the rolls of University.

f. I am aware that the University can remove my name from its rolls in case my work is not reported satisfactory by my Supervisor/Head of the Institution.

g. On admission, I shall submit myself to the disciplinary jurisdiction of the Vice Chancellor and the several authorities of the University who may be vested with the authority to exercise discipline under the Act, the Ordinances, the rules and regulations that have been framed by the University from time to time.

Signature of Candidate___________________ Name Dr./Ms./Mr. ___________________________

Dated _____________ Address for communication_________________Place _____________

EMPLOYERS CERTIFICATE FORM(FOR CANDIDATES WHO ARE IN SERVICE)

I am forwarding, herewith, the application for admission to the SSMC / PGMC Programmes in respect of Dr./Mr./Ms. _____________________ who is a full-time employee in this organization w.e.f. ____________ and has been working as ______________ (Please give designation) and his/her emoluments, including D.A., C.C.A. and H.R.A. etc. are Rs._____________.If he/she is selected by the University for admission, he/she will be relieved to join the above course as a full time/regular student in the institution assigned to him/her by the stipulated date of joining the course concerned.Note: The relieving certificate will also be sent to the University before the candidate joins the course concerned by the stipulated date.

Dated._________________ ___________________________

Place._________________ Signature of the Officer Name ____________________ Designation _______________ Official Seal

Appendix- 16


PART - E


PART - E

3333

Appendix - 17SURETY BOND

[For Post Graduate Medical Programmes (PGMC/SSMC)](On a Non-Judicial Stamp Paper of Rs. 100/-)

In pursuance of my undertaking given on ______________(date) this Surety Bond, hereafter the bond, is executed at Delhi on this ___________ (date & month) day of ________ (year) by Ms./Mr./Dr.________________________ son/daughter of Smt. __________________________ and Sh. ____________________________ hereafter the student, admitted in _____________________ (name of the course), hereafter the course at ____________________ (name of the institution) hereafter the institution, in favour of Registrar, Guru Gobind Singh Indraprastha University and the Principal/Dean/Director of __________________ (Name of the institution).

Whereas, the student has applied and has been admitted in the course, a SSMC / PGMC , being conducted by the Guru Gobind Singh Indraprastha University, Delhi.

Whereas on the basis of the merit, the student was offered various course(s) at various institution(s) available at the time of his/her counselling and he/she has voluntarily opted for the course at the ______________ (name of the institution) and he/she admitted in the course at the institution with the understanding and subject to the undertaking that the student shall undergo the course on full-time and regular basis and shall maintain the required standard of performance and shall not indulge in indiscipline/misconduct.

The student has, therefore, agreed to be liable to pay a sum of R.s. 2.0 Lacs for SSMC / Rs.3.0 lacs (for PGMC) to the institution under any of the following circumstances:-

A. If the student does not join the course at the allotted institution on or before the stipulated date.B. If the student leaves the course before its completion.C. If the admission/registration of the student is cancelled/terminated by the University on account of

unsatisfactory performance/misconduct/indiscipline.

Whereas the student undertakes that till the entire surety amount R.s 2.0 Lac for SSMC / Rs.3.0 lacs (for PGMC) is paid, the institution and/or the Guru Gobind Singh Indraprastha University shall have the right to retain the original certificates of the student.

Whereas I have requested Ms./Mr. _______________________ son/daughter of Smt.____________________ and Sh._________________________ resident of _________________________________.

and

Ms./Mr.__________________ son/daughter of Smt._________________ and Sh.________________________ resident of ____________________________ to stand as sureties severally and jointly, for me for the payment of the said amount.

Signature of the Student Name_________________ Date _________________ Place _________________


PART - E

34

That I Dr./ Ms/ Mr._______________ son/daughter of Smt.________________ and Sh.__________________________ resident of ____________________________, the student aforesaid acknowledge my indebtness to the Registrar, Guru Gobind Singh Indraprastha University and the Principal/Dean/Director of _____________________ (name of the institution) to a sum of Rs. 2 Lacs (for SSMC) / Rs.3 lacs (for PGMC), which, I hereby promise to pay on demand to the institution. Signature of the Student Name ________________ Date ________________ Place ________________

In consideration of the bond executed by the student Dr._______________ son/daughter of Smt._______________ and Sh._________________________ resident of ______________________________, in favour of Registrar, Guru Gobind Singh Indraprastha University and the Principal/Dean/Director of ________________________ (name of the institution) for a sum of Rs. 2 Lacs (for SSMC) / Rs.3 lacs (for PGMC). I_____________, hereby stand as surety, jointly and severally, for the payment of the said amount on the terms mentioned above in case the student fails to pay on demand a sum of Rs. 2 Lacs (for SSMC) / Rs.3 lacs (for PGMC), I , the said surety, shall without any objection, pay the said due amount to the institution on demand.

Date ________________ Signature __________________________Place ________________ Name of the Surety (1): _______________ Designation : _______________________ PAN : _____________________________ Present Address: ___________________ Permanent Address: _________________ Phone/Mobile No.: ___________________

In consideration of the bond executed by the student Dr._______________ son/daughter of Smt._______________ and Sh._________________________ resident of ______________________________, in favour of Registrar, Guru Gobind Singh Indraprastha University and the Principal/Dean/Director of ________________________ (name of the institution) for a sum of Rs. 2.0 Lacs (for SSMC) / Rs.3 lacs (for PGMC). I_____________, hereby stand as surety, jointly and severally, for the payment of the said amount on the terms mentioned above in case the student fails to pay on demand a sum of Rs. 2 Lacs (for SSMC) / Rs.3 lacs (for PGMC), I , the said surety, shall without any objection, pay the said due amount to the institution on demand.

Date ________________ Signature __________________________Place ________________ Name of the Surety (2): _______________ Designation : _______________________ PAN : _____________________________ Present Address: ___________________ Permanent Address: _________________ Phone/Mobile No.: ___________________

Note: The Surety Bond must be signed by either the Govt Official of Class - I or Class -II Rank, or the Persons who regularly file the Income Tax Return. The Designation and the Permanent Account Number (PAN) of the Sureties should be invariably mentioned.