INDEMNITY BOND

(An undertaking given by the parent / ward of the student of the polytechnic)

This undertaking is given by Sri / Smt_______________________________________________

aged _______ years Parent of Mr / Kum__________________________________________________
aged _______ years, PIN: _______________ Resident of ___________________________________
_______________________________ On this _________________day of ______________________

My son/daughter/ward has been admitted into the 3 year Diploma Course at

___________________ Polytechnic,________________________. The duration of the course is 3
years of theory and practical. Out of three years of study 2 ½ years at the Institution and 6 months in
the Industry for acquiring hands on experience. The curriculum of the course comprises of the
participation of the students in the Work-Shops/Labs/Industry/Organisations/Field-Works/sports
activity/Industrial exposure/NCC/NSS etc., as curricular and extracurricular activities.

In the course of participation in such of these activities the students are likely to sustain
injuries. Sometimes serious mishaps may also occur endangering life of the student for which either the
Polytechnic/Institution or the Technical Education Department/Concerned Industry/Organisation/
Corporation not at all responsible and the students are not entitled for any damage or compensation.

I also abide the safety guidelines given by the Principal which were prepared by the National
Safety Council, India and my son/daughter/ward shall follow all the guide lines for safety when they are
in the work-shops/Labs/Industry/Organization/Field work etc. applicable. Also, my son/daughter/ward
has already attended the orientation classes conducted on safety aspects at the polytechnic before
they went to the work-shops/Labs/Industry/Organization/Field work etc. applicable.

As my son/daughter/ward has already been covered INSURANCE by the

_____________________ Insurance Co. hence, I therefore, undertake not to claim any damages or
compensation either from the Polytechnic/Institution or Technical Education Department/Concerned
Indutry/Organisation/Corporation in case I/my son/my daughter/my ward sustain(s) any injury or involve
in any untoward or unexpected mishap during the course of study and Industrial attachment for
6months in the final year. We are giving this undertaking voluntarily without any force or coercion.

1.Signature of the Parent

( Name in Block Letters )
I am abiding the above
2. Signature of the Student

( Name in Block Letters )

Signature of the Witness with addresses Signature of the Principal

1.

2.