Undertaking Form to be submitted by the students for attending classes in the offline mode

I………………………….………………. Registration number …………………………………… of the programme……………………………. want to

attend the classes in the upcoming term in the offline mode. In this regard I declare that:

1. I will strictly adhere to all guidelines issued by Government of Punjab, Government of India and University
guidelines.
2. I will get my RTPCR test done as per the requirements of the University from Jalandhar/Phagwara before joining
the University. In case I will be found positive for the COVID-19, I will follow all the guidelines of university
/Government bodies with regards to quarantine and medical treatment.
3. I will wear face mask as well as any other protective gear and maintain physical social distancing in class
rooms/laboratories/academic area/hostels and in the LPU campus.
4. I will use “Aarogya Setu” App on my mobile phone and remain active on it at all the times.
5. I shall self monitor my health every day and in case of any flu like symptoms/breathing problems shall inform to
the University immediately about it.
6. I understand that there is possibility of getting infected and in such a case only I shall be responsible for the same.
7. I shall mandatorily carry my Adhaar card during my stay at the campus.
8. I am returning from the area ……………………………………………………………… that has not been declared as a
containment zone.
9. I understand that there shall be restricted movements for the students residing in the hostel as per
University/Government guidelines and I shall abide by the same.
10. In case the student or any family member of the student had ever remained affected with COVID-19 then the
student is required to submit the following details:

Relation of the Family member Period of Infection

with the student
Start Date of End Date of Infection
Infection(COVID 19 + ve (COVID 19 -ve report
report date) date)

11. I hereby declare that I am having following Medical issues for which the stated medications are being administered
to me:
Medical Issues Recommended Medication
 12. In case of any emergencies the following may be contacted:
Name: ............................................................ Contact No: ............................. Relationship
with the student: .................................................................................

Important: Please note that registration at this portal is provisional and provision for offline classes in a
particular program shall be extended on the basis of total no. of registered students for offline mode in
that program.

Signature of the Student with Date………………………………………….

Name of the Student (In Capital Letters)…………………………….

I hereby declare and confirm that I have read the complete undertaking form in detail and shall ensure
that my ward strictly adheres to the same further all the information given above is accurate and true to the
best of my knowledge and belief. I understand that I may be liable for disciplinary action for making a false
declaration.

I hereby undertake that in case my son/daughter gets affected by COVID-19 during his/her stay at the
University campus in this period, in such a case, I shall be entirely responsible for the same and in any case I or
any of my legal heir shall not hold the University as responsible for the same.

Further, in case of any kind of medical emergency in case any transportation of my ward is required I
shall be solely responsible for making arrangements for the same.

Signature of the Parents with Date

Name (In Capital Letters)