1.

DOCUMENT VERIFICATION ANNEXURE ‘A’

1. Please meet the Deputy Registrar (Academic) with the following documents in original, to complete the
admission formalities on the date of reporting, also bring one set xerox copies of the same. After making the
admission fee payment, you are also required to scan all the certificates, mark sheets, the
declarations/undertakings by the student/parents, medical proforma and upload the same in the link “Click here
to Upload Certificates” on or before 10 th July 2019 in the Applicant’s Interface after login. In all these forms
there is a column to fill “S.R. No.” that is Student Registration Number – please leave it blank while scanning
these documents. Once you upload all these documents, you will be able to print a temporary ID Card, and
Admission proforma from the system which will contain the SR Number, you can fill the same in the original
forms and submit to the Department after joining.

a. Matriculation or SSLC Certificate in original for verification of date of birth

b. Marks cards in original for all examinations from SSLC/Matriculation onwards.
c. Degree certificate of the qualifying examination.
d. GATE score card/ CSIR/UGC/DBT/ICMR JRF passing certificate / INSPRE award/provisional
award letter.
e. Candidates for Research programmes should have completed all the requirements for the award of their
qualifying degree including dissertation, project, viva-voce, etc. by 24th July 2019. At the time of
admission they should produce all the Marks Sheets and degree/provisional degree certificate issued by the
head of the Institution/University Authority. Such candidates will be given regular admission.
f. If you have completed all the formalities for the award of a degree but yet to receive the marks cards/degree
certificate of your qualifying examination, you should produce at the time of admission, a provisional
certificate from the University Registrar or Controller of Examination stating that you have completed all
the requirements for the award of the degree, including dissertation/project report/viva voce etc. as
applicable. Till this condition is fulfilled, your admission will be treated as provisional. However you
should produce the final degree certificate/marks card on or before 31st October 2019.
g. Two passport size colour photographs for issue of identity card.
h. If you belong to SC/ST category you should produce the original Certificate recently issued by the
competent authority.
i. If you belong to Person with Disability (PwD) or Kashmiri Migrant (KM) you should produce the original
Certificate recently issued by the competent authority.
j. If you belong to Economically Weaker Section (EWS) – you must produce the original Income and Asset
Certificate issued by the competent authority.
k. If you belong to OBC non creamy layer (as listed in the Central list) you should produce the original
Certificate recently issued by the competent authority.
l. Aadhaar Card to be scanned and uploaded.

2. EMPLOYED CANDIDATES : In case you are employed in a government, quasi government or government-aided
institution, or similar institution in public/private undertaking etc. you must produce a ‘Relieving Certificate’ from your
employer at the time of admission.

3. MEDICAL REQUIREMENTS : The Medical Examination Form, given below, has to be filled and signed by an
Registered Medical Practitioner and presented to the Chief Medical Officer of the Institute for his scrutiny, when you meet him
on being admitted to the Institute. The medical examination will not be done at IISc Health Centre and the cost incurred for the
medical examination will not be reimbursed. Your admission is subject to your being declared physically fit by the Institute
Medical Officer for undertaking the course.

4. DECLARATION BY PARENT/ GUARDIAN : You must fill in the ‘Declaration by Parent/Guardian’ form given below,
and submit at the time of reporting.
Dear Prospective Student,

Please find below the forms which are to be filled in and duly signed by you/parents appropriately
after making the admission fee payment and upload the same online accordingly in the link “Click
here to Upload Certificates” in the Applicant’s interface after login on or before 10 th July 2019 and
carry the original forms along with you while coming for reporting. Your admission status is based
on the documents submitted by you, if all the documents are submitted online then your admission
will be confirmed admission or else it will be provisional till such time you produce the same.

1. Medical Examination Form

2. Declaration by the parent/guardian
3. Undertaking by the parent/guardian
4. Undertaking by the Student
5. Travelling Allowance (TA) Form – to be filled and submitted at the department.

In addition you are also required to bring a print out of the following
a. Online application form.
b. Admission offer letter and
c. One set of copies of certificates/mark sheets from 10th Std onwards.

Further, after uploading the above documents, you must enter your bank account details (only SBI
or CANARA Bank accounts are acceptable) by clicking on “Update Bank Account Number” after
login in the Applicant’s interface and enter your Aadhaar Card ID number. In case you do not have
an account, you must open a Savings Bank account in your name either in CANARA BANK or
State Bank of India, in the Campus branch after joining the Institute.

You should produce all these print outs together at the counter in the Faculty Hall where you will
be given a token number on first come first serve basis.

Please note: Using of motorised vehicle is restricted in the Campus and

hence all are requested to use bicycle for transportation within the
campus.

For your information on arrival at Bangalore for admission – Accommodation is provided only after the
admission formalities are completed. Hence students who are coming one/two days before the reporting
dates may stay at their convenient place and come for reporting on the dates given in the offer letter. It may
also be noted that the accommodation will not be provided to the parents.
Indian Institute of Science is popularly called ‘TATA INSTITUTE’ in Bangalore. It is situated at a distance
of approximately 6 Kms. from the Bangalore City Railway Station/City Bus Station/Cantonment Railway
Station and within 2 Kms. of the Yeshwanthpur Railway Station. Bus numbers from Bangalore City Bus
Station are 273, 276, 99A, 99B, 272, 252.

Regards,

Deputy Registrar
Academic
 STUDENTS MEDICAL EXAMINATION FORM

1. Examination by a General Physician (M.D. in General Medicine)

I Dr. ……………………………………………………………………………………….. after examining (with

necessary investigations) Mr./Ms. ……………………………………………………………… son / daughter of

Mr./Ms. …………………………………………………………………… born on………………………………

CERTIFY

Weight …………………kgs, Height …………………cms Blood Pressure ……………………..…mm Hg

Girth of Chest (a) At rest ………………….. ……………... (b) After deep inspiration …………………….

Cardiovascular System ……………………………………. Heart ……………….Heart Sounds…………...

Respiratory System ………………………………………...

Neurological System ………………………………………...

Psychological disturbance Yes / No. If yes, specify …………………………………

Past Medical or Surgical Record ………………………….. ………………………………………………….

Identified allergies ………………………………………………………………………………………………...

Current treatments ………………………………………………………………………………………………...

A. In addition to the childhood vaccination the following adult boosters are recommended as pre-admission
compulsory vaccination:
1. Typhoid
2. Hepatitis A
3. Hepatitis B
4. MMR. 1 Dose after age of 15 years
5. Chicken pox
6. DT/Tdap

B. Recommended but not mandatory vaccination : Meningitis

C. Only those candidates in whom vaccination is medically contraindicated will be exempted from these vaccination
on production of medical certificate.
D. Proof of having received the mandatory vaccination is must at the time of admission.

Date:

Place: Signature & Seal

….2
2. Examination by Opthalmologist*

Aculty of Far Vision Near Vision Colour

Vision Vision
Naked Eye With Glasses Naked Eye With Glasses
R.E
L.E

*Latest Optometrist’s Recommendations, if any to be attached in original,

Remarks/ Special Recommendation, if any.

I Dr. ……………………………………………………………………………………….. have examined (with

necessary investigations) Mr./Ms. ……………………………………………………………… son / daughter of

Mr./Ms. …………………………………………………………………… born on………………………………

and the above information given to the best of my knowledge are correct and true.

Date:

Place: Signature and Seal

1. Examination by ENT Specialist*

Inspection / hearing *Audiometry

Right Ear
Left Ear

*Latest Audiometry report to be attached in original

Remarks / Special Recommendations, if any.

I Dr. ……………………………………………………………………………………….. have examined (with

necessary investigations) Mr./Ms. ……………………………………………………………… son / daughter of

Mr./Ms. …………………………………………………………………… born on………………………………

and the above information given to the best of my knowledge are correct and true.

Date:

Place: Signature and Seal

….3
INVESTIGATIONS

DETAILS DATE RESULT

1.Electrocardiogram*
2. Chest X-Ray*
3.Sonography (whole abdomen)*
4.Urine*
5.Blood Tests*
Blood Sugar (F/PP)
Urea/ Creatinine
Peripheral Smear Study/HB%
Lipid Profile
Blood Group/ typing (if not known)
HBS Ag
*All original investigation reports (only) to be attached.

Remarks / Special Recommendation, if any:

Conclusion: Fit/ Unfit to pursue higher education with a very tight academic schedule.

Date:

Place: Signature & Seal

Signature of the candidate ……………………………………………………………………………

Note: The medical examination will not be done at IISc Health Centre and the cost incurred for the medical
examination will not be reimbursed.

For Office Use only

S.R. NO.
Date of admission
Department
Program

*****
 INDIAN INSTITUTE OF SCIENCE, BANGALORE
DECLARATION BY PARENT/ GUARDIAN on code of conduct

Name of the Student ___________________________________

Father’s Name ___________________________________

Mother’s name ___________________________________

Guardian’s name ___________________________________

(in case parents are not there)

Annual Income ___________________________________

(including all sources)

Permanent Address of parents___________________________________

___________________________________

___________________________________

Telephone No. with STD code: _____________________

Mobile No: _____________________

In the event of Mr/Miss/Mrs. ______________________________________________________

being admitted to the Institute, I shall be responsible for his/her conduct conducive to the academic
activities of the Institute, as well as support at the Institute.

Place:
Date : Signature of the Parent/Guardian
Name:
 INDIAN INSTITUTE OF SCIENCE, BANGALORE
UNDERTAKING BY PARENT/GUARDIAN on anti-ragging

1. I,__________________________________________________________________________
F/o./M/o,G/o.of Mr./Mrs./Ms._____________________________________________________
have carefully read and fully understood the law prohibiting ragging and the directions of the

Supreme Court and the Central/State Government in this regard as well as the UGC Regulations on

Curbing the Menace of Ragging in Higher Educational Institutions, 2009, and agree to abide by the

same by my ward.
2. I assure you that my son/ daughter/ ward will not indulge in any act of ragging,
3. I hereby agree that if he/she is found guilty of any aspect of ragging, he/she may be punished as

per the provisions of the UGC Regulations mentioned above and/or as per the law in force.
4. I have gone through the conduct rules specified by UGC on their website (www.ugc.ac.in) and

agree to abide the same by my ward.

Signed this _____________________ day of ___________________ month of _______________year

Signature of the Parent/Guardian

Name :

Address :

Department of SIGNATURE OF THE CHAIRMAN

 INDIAN INSTITUTE OF SCIENCE, BANGALORE

UNDERTAKING BY THE STUDENT on anti-ragging

1. I,_____________________________________________________________________________
S/o. D/o. of Mr./Mrs./Ms._________________________________________________________
have carefully read and fully understood the law prohibiting ragging and the directions of the
Supreme Court and the Central/State Government in this regard.

2. I have read the “UGC Regulations on Curbing the Menace of Ragging in Higher Educational

Institutions, 2009” dated 17th June, 2009 (www.ugc.ac.in) and agree to abide by the same.
3. I hereby understand that
 I will not indulge in any behavior or act that may come under the definition of

ragging,
 I will not participate in or abet or propagate ragging in any form,
 I will not hurt anyone physically or psychologically or cause any other harm.
4. I hereby agree that if found guilty of any aspect of ragging, I may be punished as per the provisions

of the UGC Regulations mentioned above and/or as per the law in force.
5. I have gone through the conduct rules specified by UGC on their website (www.ugc.ac.in) and agree

to abide the same.

6. I hereby affirm that I have not been expelled or debarred from admission by any institution.

Signed this _____________________ day of ___________________ month of _______________year

SR Number: Signature of the Student

Department of SIGNATURE OF THE CHAIRMAN

 INDIAN INSTITUTE OF SCIENCE, BANGALORE

UNDERTAKING BY THE STUDENT on usage of motorized vehicles in the campus

1. I,_____________________________________________________________________________
S/o. D/o. of Mr./Mrs./Ms._________________________________________________________
have fully understood the Institute norms that students are prohibited from using motorized
vehicles within the campus and that to facilitate movement of students PEDL Systems of hiring
bicycles at a nominal cost has been in vogue at the Institute campus.

2. I hereby agree that I will abide by the norms by not using the motorized vehicles in the campus

and also agree to abide the decision taken by the Institute Administration in case of violation in

this regard.

Signed this _____________________ day of ___________________ month of _______________year

SR Number: Signature of the Student

Department of SIGNATURE OF THE CHAIRMAN

 INDIAN INSTITUTE OF SCIENCE, BANGALORE

DECLARATION BY THE STUDENT on code of conduct

I _____________________________________________________ son / daughter of

______________________________________________________ hereby declare that
on admission I will endeavour to complete successfully my Research/ Course program
for which I have been admitted to the Institute. I hereby affirm that I accept the code of
ethics* and conduct in this regard and undertake to the best of my capability to complete
my studies in the Institute. For any breach of code of conduct in this regard, I am aware
that:
(i) I will be expelled from the Institute
(ii) I will not be eligible for readmission as a student of the Institute for a period of
three years, and
(iii) I will not be eligible for a grade card or certificate for the course studied or work
carried out by me as part of the program for which I was admitted.

Further, I also declare that if for any legitimate reason, I am forced to discontinue, I would
do so only on prior intimation and permission from the Chairman of the Department.

S R Number :

Date : SIGNATURE OF THE STUDENT

Department of

SIGNATURE OF THE CHAIRMAN

* including the Internet Access and Network Usage Policy

(http://www.serc.iisc.ernet.in/network/internet-usage-policy.htm)
 INDIAN INSTITUTE OF SCIENCE, BANGALORE 560012
TRAVELLING ALLOWANCE FORM
RESEARCH PROGRAMMES FOR THE SESSION 2019
1 TA for having attended the interview on Date 20 – 24 May 2019 AMOUNT
Rs. Ps
Travelled by Train / Bus From :
To : BANGALORE
Ticket No: (please attach the tickets) Date of journey :
2 TA for joining the Institute on date : 24 July 2019
Travelled by Train / Bus From :
To : BANGALORE
Ticket No :
TOTAL
Note: Please attach the government bus ticket or train tickets only (if travelled by train in sleeper class), else do the following:

Open the website www.erail.in and key in your departure and arrival destinations, select General Quota and Sleeper Class and
then click on Get Trains - you will get list of trains. Then click on the Express train, then you will get the complete details of the
train including fare for the journey. Take a print out of the same and attach it to this TA Bill, claim will not be considered without
the print out (specimen is attached here below). You must enter only the Train Sleeper Class fare in the columns provided above
for the claim, even if you travel by any other means (like may be by flight or by A/C class or etc.,).

I declare that the above mentioned particulars are true to the best of my knowledge.

Date : Application no: Signature of the candidate

Bank Account No: Name of the Bank:

Branch: IFSC Code:

FOR DEPARTMENT USE ONLY

Certified that Mr / Ms. _______________________________________________________ Application no. __________ has

attended the interview on _______________ at __________ hours in this Department for Research Programme. He / She
may be paid the travelling allowance as follows :
1 Single second class railway fare by the shortest route from the place of journey to the Institute and back for having
appeared for interview.

Date : Signature of the Chairman

Department:

FOR ACCOUNTS SECTION USE ONLY

DEBIT : Contingency Grant of :

TA of Rs. ______________ ( Rupees ____________________________________________________ ) is sanctioned.

SUPERINTENDENT ACCOUNTS OFFICER

ACKNOWLEDGEMENT
Received Rs. ___________ (Rupees _______________________________________________________ )

Stamp
Date : Signature
 INDIAN INSTITUTE OF SCIENCE, BANGALORE 560012
TRAVELLING ALLOWANCE FORM
(ONLY FOR SC/ST CANDIDATES)

TO BE FILLED BY THE STUDENTS JOINING THE INSTITUTE TO RESEARCH PROGRAMMES FOR

THE SESSION 2019

1 TA for joining the Institute on Date : 24 July 2019 AMOUNT

Rs. Ps
Travelled by Train / Bus From :
To : BANGALORE
Ticket No: (please attach the tickets) Date of journey :
TOTAL
Note: Please attach the government bus ticket or train tickets only (if travelled by train in sleeper class), else do the following:

Open the website www.erail.in and key in your departure and arrival destinations, select General Quota and Sleeper Class and
then click on Get Trains - you will get list of trains. Then click on the Express train, then you will get the complete details of the
train including fare for the journey. Take a print out of the same and attach it to this TA Bill, claim will not be considered without
the print out (specimen is attached here below). You must enter only the Train Sleeper Class fare in the columns provided above
for the claim, even if you travel by any other means (like may be by flight or by A/C class or etc.,).

I declare that the above mentioned particulars is true to the best of my knowledge.

Date : Signature of the candidate

S.R.NO:

FOR DEPARTMENT USE ONLY

Certified that Mr / Ms. _______________________________________________________ S.R. No. ________________

has joined this Department for Research/ Int. Ph D program. He / She may be paid the travelling allowance as follows :
1 Single second class railway fare by the shortest route from the place of journey to the Institute for joining.

Date : Signature of the Chairman

Department:

FOR ACCOUNTS SECTION USE ONLY

DEBIT : Contingency Grant of :

TA of Rs. ______________ ( Rupees ____________________________________________________ ) is sanctioned.

SUPERINTENDENT ACCOUNTS OFFICER

ACKNOWLEDGEMENT
Received Rs. ___________ (Rupees _______________________________________________________ )

Stamp
Date : Signature