‘Organizing Institute: IISc Bangalore Annexure-1 JAM 2021 UNDERTAKING FORM (To be given by a candidate who has NOT submitted the required documents) 1. Name: |SouRAV SAMAPDAR _] 2. Enrolment ID: S101Z24 aon, 3. Test Paper(s): 1. CHEMISTRY (x) 2 4. All India Rank(s): 1. | 3#I 2. 5. Category (GEN/GEN-EWS/OBC-NCLISC/ST) SC 6. PwD Status (Yes/No): NO | understand that my application for JAM 2021 admission is incomplete since | have not submitted the following document(s) (as per the requirements stated in Sections 4 and 5 of the Admission Brochure for JAM 2021) due to the prevailing conditions of Covid-19. [Please tick the missing document(s)]. Qualifying degree certificates Wark sheet(s) Nationality certificate © Category certificate (if applicable) Pw0 certificate (if applicable) o | also understand that | need to upload the missing document(s) at the admission portal on or before July 12, 2021 for my application for admission to be complete. | also understand that any admission offer made to me will be provisional and my failing to upload the missing document(s) at the admission portal by July 12, 2021 will result in withdrawal of the offer. | also understand that, if finally admitted, | need to fulfil the eligibility criteria and minimum. educational qualification requirements of the admitting institute and submit the required documents to the admitting Institute on or before September 30, 2021, failing which my admission will stand cancelled. 4 wrest aed aH Signature of the Candidate Cee 04/21 Place KOLKATA Nitha Sorellal. Countersigned by the ParenvGuardian