SELF ATTESTED APPLICATION FOR OPTING OUT OF NOVEMBER2020 EXAMINATION AND APPEARING IN JAN2021/FEB2021 EXAMINATION / MAY2021 EXAMINATION T cacn | davgser ot KAM LEC Kirmnt_VA00 bom on 3/01 Registration Number_C R (7999 CD47 Roll No, ‘Wish to affirm and undertake as under: 1. Thave made application for appearance in the November2020 examination during 05-08-2020 to (04-09-2020 / 09-09-2020 to 11-09-2020 2. Lat my own free will have decided to Opt out of the November2020 examination and in lieu of the same opting to appear in : © January2021/February 2021 exams - second tranche of November 2020 examination OR @ May2021 exams due to following reasons: I declare that [ am COVID-19 positive or having symptoms of COVID-19 {J b. Idectare that my family members with whom I am staying are COVID-19 positive ¢. I declare that my residence is located in an area which is declared as Containment Zone by the Central Governmen/State Government/Local Authorities 3. Tunderstand that by making this application I am withdrawing my November2020 examination application and will NOT appear in the November2020 examination / remaining papers of November2020 examination 4, request that unexpired exemption if any valid for the November2020 examination be carried forward for my appearance in Jan2021/Feb2021 examination / May2021 examination 5. Thereby agree that in case I do not appear in the Jan2021/Feb2021 examination / May2021 examination I shall not claim any benefits like carry over of exemptions / fees refund etc, for the same Signature of the Candidate: Bee Signature of the Parent (in case the candidate/examinee is a Minor) Date. 13] Joo00 Place:_ TAGT ROAD ASoAM