Name of the state Komble. Tejaswini Anil ‘Chass and bra TYycsk_A Residential address: MobileNos _ gig0644937 : Signature of the student: “AG iz / ‘My spd / daughter / yafd Me. MsFombleTgasssins Ani). is studying in TY CSE A (class and branch) of this Institute. 1 am aware of the above undertaking provided by my efi 1 daughter / wafd. I hereby assure that my ge / daughter / yeSid will remit the Scholarship / Free ship amount to the Institute within seven days from the date of receipt ‘of the amount fiom the Government. Ifthe amount is not paid to the Insitute within the “stipulated period, I am aware that appropriate action will be initiated against my sah Haught by thers. Piet eiving the wodertaking/dectaration that, myself my ward are solely responsible for the same. Name of the Parent/Guardian: Kam ble_Aoik Vishnu Contact Number: 962419 64.85Name ofthe student: Komble “T ejasswin' Class and branch: : A Residential address: Mobile No — giac anure of the stat Date: ‘My spqf / daughter / yafd Me. MMs omble Tgussin Api) is studying in TY CSE A (lass and branch) of this institute, 1am aware ofthe above undertaking provided by my eft 1 daughter / wafd. 1 hereby assure that my gaft / daughter (pedid will remit the Scholarship / Free ship amount to the Institute within seven days from the date of receipt of the amount fiom the Governnent, Ifthe amount is not paid to the Institute within the stipulated period, 1 am aware that appropriate action will be initiated against my ei ‘aughter / id by the Institute, “Tam giving the undertaking/declaratfon that, myself & my ward ane solely responsible for the same. ‘Name of the Parent /Guardiam: Kamble Maid Vishnu: Contact Number: 9628106485 Foal ee Signature: