Pro forma -O

(For seats under Minority Quota)

MINORITY COMMUNITY STUDENT'S SELF DECLARATION

I, Jaspreet Kaur Daughter/of Mohan Singh Babrah

Resident of Hindustan Mech. Eng. Works, Mohan Nagar, Nagpur-440001

I belong to the Sikh religious minority community and / or as my mother tongue is not mentioned in my
leaving/Transfer certificate for deciding my candidature under linguistic minority status. I under take
that my mother tongue is Punjabi.

I undertake to submit the relevant document supporting my claim for belonging to minority community
as per Government Resolution minority department No. 3fafa-2090/9.35. 10/90/qui-4, feci5
09.019.3093 at the time of admission to the admitted institute.

Date : 22/08/2021 Signature of Candidate:

Place: Nagpur Name of Candidate: Jaspreet Kaur

(*strike out whichever is not applicable)