DECLARATION CUM UNDERTAKING

Declaration cum Undertaking for Beneficiary of …………………….. Scheme for 2018-19.

I ………………………………………………S/D of ………………………………. hereby undertake

that, I am the beneficiary no……………. of my family for the said Scheme for A.Y.

2018-19.

I also hereby declare that, in my family not more than two beneficiaries has

applied for the said same Scheme for A.Y. 2018-19.

Sign : ………………………………………………

Name of the Student : ………………………………………………………………………………………

Application ID : ………………………………………………………………………………………

College Code : ………………………………………………………………………………………

Class & Branch : ………………………………………………………………………………………

Sign : ………………………………………………………………………………………

Name of Parents/Guardian : …………………………………………………………………………………

Date : ……………………