In Order?

Remarks
Copies of the certificate submitted
Y / N / NA (PGPM OFFICE)
NAME:
CAT ID: Roll No: Section:
ID-Proof:
(Aadhar Card / Pan Card / Driving License)
CATEGORY: (  the category and strikeout remaining field) GEN / SC / ST / NC-OBC / DAP / EWS
Community Certificate (SC/ST)
DAP Certificate
NC-OBC Certificate
EWS Certificate
UG Education Certificate(s)
A. (i) UG Degree Certificate
(ii) If not having Degree Certificate
(Submission of UG Degree Undertaking form)
B. Provisional certificate / Consolidated Mark Sheet /
Semester-wise Mark Sheet
PG Education Certificate(s)
PG DEGREE COMPLETED
Master Degree Certificate
Master Degree Mark Sheets
Work Experience Certificates
DO YOU HAVE WORK EXPERIENCE
(A) Work Experience Certificate
(B) Relieving letter
(C) Latest Pay slip (or) Salary Certificate
Medical Certificate
(A) Government Doctor Medical Certificate
(Duly signed with seal)

(B) Private Doctor Medical Certificate

Undertaking
Undertaking (Anti Raging- signed by student and parent)
Undertaking (Overall)
Declaration
 I hereby declare that the information submitted in this checklist is true and accurate. In case any
information given in this checklist proves to be false or incorrect, I shall be responsible for the
consequences. I also declare that if any information provided by me is found false, my candidature may
be rejected at any point of time.

Signature