STUDENTS’ GYMKHANA

INDIAN INSTITUTE OF TECHNOLOGY BHUBANESWAR

Nomination Filing Form (Gymkhana Election 2018)

1. Nomination is for the post of:

2. Name of the Candidate:

3. Roll No.

4. Address at IIT Bhubaneswar:

5. Name of the School:

6. Semester:

7. CGPA:

8. Is the candidate having any back paper (Tick): Yes / No

9. Candidate has relevant eligibility as per Yes / No

Annexure-II (Tick):
(Please attach all relevant document proof and
certificates)
Candidate’s Declaration:
I hereby declare that the above information is true to the best of my knowledge and belief. If any
information is found incorrect, my candidature is liable to be rejected.

Place:
Date: Signature of the Candidate

Proposer Details
We declare that we are having voting rights in the Students’ Gymkhana Election and appending our
signature below in support of this nomination.
Proposer-1: Proposer-2:
Signature: Signature:

Name: Name:
Roll No.: Roll No.:
School: School:
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Note: Duly filled nomination form shall be submitted to the Office of the Students’ Gymkhana, Room
No: 315, SES, Argul Campus, IIT Bhubaneswar/Office of Student’s Gymkhana, Mahanadi Hall of
Residence, Argul Campus, IIT Bhubaneswar. You need to sign on the submission form kept at both
location.
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Ref. No:

The relevant documents and the form are checked and the candidature is found:

Acceptable / Not Acceptable

If found Not Acceptable, reason thereof:

Place: Date: Signature of the Election Officer

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