Professional Documents
Culture Documents
Address0
UNDERTAKING-II
2 am a#are that ra))in) is banned in 22M 5o6hi7ode and if my
son/dau)hter/#ard is found )uilty of ra))in)( he/she #ill be liable for
appropriate punishment #hich may include e*pulsion from the 2nstitute.
Date0 1i)nature of the /arent
"ame of the /arent
Address0
JJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ
/hone "o.
Date 0 Desi)nation0 District Ma)istrate/Addl. District Ma)istrate/City Ma)istrate/ /ar)ana
Ma)istrate/Tehsildar/Dist. .ari,an3cum31ocial >elfare =fficer
(!ound 1eal) (=ffice 1eal)
H /lease delete the #ords #hich are not applicable
HH /lease +uote or tic7 specific /residential =rder
S3!$)!"
D)*a4)()#y C!2#),)$a#!
(to be issued by a Director/Dy. Director/Member of District Medical Board)
This is to certify that Mr. #hose particulars
are )i-en belo# has been thorou)hly e*amined by me and found that he/she is a person #ith disability of Do#
Kision/Blindness/.earin) 2mpairment/Docomotor Disability/Cerebral /alsy/. .is
disability is percent and he/she comes under the cate)ory of Moderate/1e-ere//rofound (Total)
disability.
1. "ame 0
$. A)e/Date of Birth 0
9. 1e* 0
'. 2dentification mar7s 0
%. 8atherAs name 0
4. "ature of the disability 0
?. /ercenta)e of disability 0
@. 1i)nature of the applicant 0
1i)nature of the Doctor0
!ound 1eal "ame of the Doctor0
Desi)nation0
Address (or seal)
/lace0
Date0
(The minimum de)ree of disability in order for a person to be eli)ible #ould be '0L)
1pecimen
Affida-it s#orn before the "otary
2( 1ri. son of
born on (date) ( residin) at
do hereby solemnly affirm the
follo#in)0
1. 2 belon) to the =ther Bac7#ard Class (=BC) of the society as defined in column 9 of
the 1chedule to the ;o-ernment of 2ndia( Department of /ersonnel B Trainin) =.M. "o.
9401$/$$/C93<stt.(1CT)( dated @.C.C9. and the contents of the Certificate dated
issued thereof by submitted by me is true and correct.
$. 2 ha-e read and understood the meanin)( purport and scope of the definition of
persons /sections e*cluded from reser-ation #hich constitute the Creamy Dayer of the
society as declared and notified by the ;o-ernment of 2ndia( "ational Commission for
Bac7#ard Classes ("CBC).
9. 2 declare that 2 am not a person of the Creamy Dayer of the society e*cluded from
reser-ation for =ther Bac7#ard Classes (=BC)( defined and cate)ori6ed by the
;o-ernment of 2ndia( on its official #ebsite of the "ational Commission for Bac7#ard
Classes ("CBC) http///ncbc+nic+in
'. 2 underta7e to pro-e and clarify and or ans#er to any +uery in connection #ith any
part of this affida-it( declaration and underta7in) made herein by me( to the satisfaction
of the 22M5 Admission authority or any other re)ulatory authority at any point of time
before and after admission.
%. 2 declare and underta7e to abide by the decision of the 22M5 Admission authority
cancellin) my admission in the 2nstitute at any point of time before and after admission in
the e-ent it is found that 2 am a person belon)in) to the Creamy Dayer of the society of
=BC #ho are e*cluded from reser-ation for admission as =BC.
4. 2 declare that there is no suppression of facts in this affida-it by me and no part of this
Affida-it is false and/or contains incorrect statements.
?. 2 s#ear and affirm that all particulars( declaration and underta7in) )i-en in the
fore)oin) para)raphs are true and correct to the best of my 7no#led)e( information and
belief( and 2 ha-e not resorted to suppressin) truth or su))estio falsi.
The statements made in the fore)oin) para)raphs 1 to 4 of the affida-it are true and
correct.
Deponent
2dentified by me
Ad-ocate
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